Thisbookisdedicatedtothememoryofmyfather,DonaldM.Barnard,MD,a
kindandwisephysician,andtotheparticipantsinourresearchstudies.Iam
deeplygratefulforyourimportantcontributiontothiswork.
“Dr.Barnard’ssolidscientificwork…representsamajorturningpointinthe
treatmentandoutcomeofdiabetes.Revolutionaryinitsimplicationsand
spectacularinitsclarity,thisbook—withitssimple,safedietaryapproach—will
bringhopetomillions.”
—HansDiehl,DrHSc,MPH,FACN,chairmanoftheLifestyleMedicine
InstituteinLomaLinda,California,anddirectoroftheInternational
NutritionresearchFoundation
“Dr.Barnard’ssuperbbookshowsusthenumerousadvantagesoffollowinghis
nutritionalprogram.”
—WilliamC.Roberts,MD,editorinchiefoftheAmericanJournalof
CardiologyandexecutivedirectorofthebaylorHeartandVascularInstitute
inDallas
“Apromisingalternativedietaryapproachinthetreatmentofdiabetes.”
—WilliamE.Connor,MD,professorofmedicineandclinicalnutritionat
OregonHealthandScienceUniversityinPortland
CONTENTS
ACKNOWLEDGMENTS
INTRODUCTION:ANEWAPPROACHTODIABETES
PART1.THEBREAKTHROUGH
CHAPTER1.TheNewBasics
CHAPTER2.ReversingType2Diabetes
CHAPTER3.ARevolutioninType1Diabetes
PART2.THEPROGRAM
CHAPTER4.APowerfulNewMenu
CHAPTER5.HowtoGetStarted
CHAPTER6.HealthfulWeightControl
CHAPTER7.HowtoTestYourselfandTrackYourProgress
CHAPTER8.APerfectDietinanImperfectWorld
CHAPTER9.Troubleshooting
CHAPTER10.WhichSupplementsShouldYouTake?
CHAPTER11.ExercisefortheRestofUs
PART3.COMPLETEHEALTH
CHAPTER12.AHealthyHeart
CHAPTER13.HealthyNerves,Eyes,andKidneys
CHAPTER14.InformationforClinicians
MENUSANDRECIPES
NOTES
ACKNOWLEDGMENTS
I would like to thank the many doctors, nurses, dietitians, and people with
diabetes who used the first edition of this book and shared their experiences
alongtheway.Theyhaveunderscoredthepowerofthisapproachandthegreat
needforitatatimewhenthecausesofdiabetesandthenutritionalapproachtoit
remainonlydimlyunderstoodbyasurprisinglylargenumberofcaregiversand
patients.
Theresearchthatculminatedinthisbookwasateameffort.Iespeciallywant
toexpressmydeepestappreciationtotheresearchvolunteerswhoputupwith
manyearly mornings,late nights,and needlesticksin performingan important
public service. You have taught me a great deal and helped our research
immeasurably.
I greatly appreciate the support of the National Institute of Diabetes and
DigestiveandKidneyDiseasesoftheNationalInstitutesofHealth,particularly
Sanford Garfield, PhD, and of the Diabetes Action education and Research
Foundation and its director, Pat DeVoe, RN, BSN, without which our initial
researchondiabetes wouldnothave beenpossible.Thankyou alsotoGEICO
forallowingustotestthisapproachintheworksettingincitiesacrosstheUS
and to the American Diabetes Association for the opportunity to share our
findingsalongtheway.
JoshuaCohen,MD,ofthedivisionofendocrinologyatGeorgeWashington
University,wasinstrumentalinplanningandguidingourresearchwork.David
J.A.Jenkins,MD,PhD,DSc,oftheUniversityofToronto,isanextraordinary
mentor whose generosity with his time, knowledge, and ideas is something I
hopetopassontootherinvestigators.
CarolineTrapp,DNP,ANP-BC,CDE,FAANP,hasappliedthisapproachin
extraordinary ways in her clinical work and in her innovative programs with
NativeAmericansand,alongwithMeghanJardine,MS,MBA,RDN,LD,CDE,
haseducatedandempoweredthousandsofcaregivers.
Susan Levin, MS, RD, Francesca Valente, Rosendo Flores, Jill Eckart,
SuruchiMishra, PhD,Joseph Gonzales,RD,Gabrielle Turner-McGrievy, PhD,
RD,andLisaGloede,RD,CDE,helpedextensivelyinresearchplanningandin
guiding our research participants toward more healthful ways of eating. Brent
Jaster,MD;AmberA.Green,RD;KimSeidl,MS,RD;TrulieAnkerberg-Nobis,
RD;DulcieWard, RD;JenniferReilly,RD;and MaryEllenWolfe, RN,CDE,
andRobynWebbsharedtheirexpertiseandguidancewithmeandourresearch
participants.ThankstoPaulPoppen,PhD,forhisexpertassistanceinplanning
andexecutingthestatisticalanalyses.AndrewNicholson,MD,andMarkSklar,
MD, guided our initial research on diabetes, and Larry Kushi, PhD, provided
thoughtful advice along the way. John A. McDougall, MD, and Mary
McDougallprovidededucationalmaterialsandwonderfulrecipes.JennieBrand-
Miller,PhD,oftheUniversityofSydney,kindlyansweredmanyquestionsabout
herstudiesoftheglycemicindexanditsuseinclinicalpractice.
Stanley Talpers, MD, kept a watchful eye on medical issues for our
participants,andBradMoore,MD,servedasoursafetyofficer.
SpecialthankstoErnestP.Noble,MD,PhD,andTerryRitchie,PhD,ofthe
University of California, Los Angeles, for their generosity and expertise in
genetic analyses. Thank you to Donald S. Karcher, MD; Terry Costa; Luce
Merino; Estela Day; Patrice Moore; and everyone at George Washington
Universityclinicallaboratoryclientservices.
CaelCroftprovidedthewonderfulmedicalillustrationsinthisbook.
Finally,thankyoutomyliteraryagent,BrianDeFiore,andmyeditor,Marisa
Vigilante,forhelpingtoshapethisbookintoitscurrentform;andBryannaClark
Groganforprovidingwonderfulrecipes.
INTRODUCTION
ANewApproachtoDiabetes
This book presents a revolutionary method for preventing, controlling, and
reversing diabetesbased on important researchfindings that have dramatically
changedourunderstandingofthiscondition.Whenthisbookfirstappeared,the
ideathatdiabetescouldimprovedramaticallyandsometimesevengoawayfor
allintentsandpurposeswasanovelconcept.Theprevailingnotionwas“once
youhavediabetes,you’llalwayshavediabetes,”andtheconditionjustseemed
toleadtomoreandmorecomplications.Wehavechangedthatscenario.
In studies by my research team, funded by the US government’s National
InstitutesofHealthandtheDiabetesActionResearchandeducationFoundation,
along with the work of other researchers, we have completely redesigned the
dietaryapproach todiabetes. Ifyourexperience withdiabetes hasbeenone of
gradually escalating medication doses, ever-increasing weight, and increasing
worry about the risk of complications, you will learn how to reverse those
trends.
Wewillfocusonchangesinyourmenu,notondrugs.Yes,medicationsoften
have their role. But I would much rather help you scale back on drugs—or
eliminatethementirely.Doingthatmeansrethinkingthefoodsthatyoueat.Let
meemphasizethatyouwillnotneedtocutcalories,limitcarbohydrates,orstick
to small portions. In fact, you can eat until you are full. If you get hungry
betweenmeals,youarefreetoeatmore.Whatwewillzeroinonisthetypeof
foodyoueat.Thathasemergedasthecriticalfactor,asyouwillsoonsee.
ANEWIDEA
My father, Donald M. Barnard, MD, spent hisentire life treating diabetes. He
grew up on a family farm in the Midwest but soon realized that the cattle
businesswasnotforhim.Hedecidedtogotomedicalschool,andaftertraining
atBoston’sfamed JoslinClinic,hebeganwork atabusy communityhospital.
Hebecameknownasthediabetesexpertforthesurroundingarea.Butheandthe
otherdoctors—andtheirpatients—oftenfounddiabetespuzzlingandfrustrating.
Herecounteda tellingcommentmadeby theclinic’sfounder, ElliottP.Joslin,
MD,about diabetesresearch: “Gentlemen,wedon’tneeda bigresearchgrant.
Whatweneedisanewidea.”
Dr. Joslin made that observationback in the 1950s, and the need has only
grown more urgent as the incidence of the disease has exploded. Worldwide,
more than 400 million people are living with diabetes. Until now, most have
foundtheconditiontobeatbestanexerciseindrudgery.Withdailybloodtests
andagrowinglistofmedicationsthataimonlytoslowthedisease’sinevitable
damage,apatient’slifebecomesawaitinggame,withonecomplicationarising
after another—from nerve symptoms to visual changes and heart and kidney
problems.
Now,atlast,wehaveamuchmorepowerfulapproach.I’mtalkingnotjust
aboutaboldnewidea,butaboutanentirelynewapproachtodiabetesthathas
beentestedandproven.
In a series of research studies conducted first with Georgetown University
and George Washington University in Washington, DC, our research team has
proven that many people with diabetes can think beyond delaying inevitable
decline and improve their health dramatically. They can cut their blood sugar,
increaseinsulinsensitivity,andreduceoreliminatemedications,andtheycando
this with a simple set of diet changes. Unlike with medication treatments, the
“sideeffects”ofthemenuchangearegoodones:weightloss,lowercholesterol
levels,lowerbloodpressure,andincreasedenergy.
From the beginning, our studies aimed higher and took a more aggressive
approachtodiabetesthanclinicianshadinthepast.Thefirststudywassmall—
just13patients—andittestedaprogramthatreliedentirelyonchangesindiet.
Therewasnonewdrug,nomagicalsupplement—notevenanexerciseprogram.
Buttheresultswereamazing.Two-thirdsofpatientsimprovedsomuchthatthey
wereabletoreduceoreliminatetheirmedicationswithin12weeks.Thestudy
waspublishedinPreventiveMedicinein1999.
1
Then,inasecondstudy,thisoneinvolving59patientswithvaryingdegrees
of blood sugar control—some healthy, others prediabetic or diabetic—we
studiedwhydietchangeworks.Itbecameclearthatthedietshiftactuallycaused
afundamentalchangeinthebodyitself.In14weeks,thedietledtoa24percent
improvement in insulin sensitivity—that is, the body’s ability to respond to
insulin,thesugar-storinghormonethatisdysfunctionalindiabetes.Participants
whosebloodsugarlevelswereintheabnormalrangesawthempromptlyreturn
towheretheybelonged.Whileexercisecouldincreasethebenefitsevenfurther,
dietchangesalonewerepowerfulenoughtoboostinsulinsensitivityandbring
blood sugar under better control. The results were presented at the American
Diabetes Association Scientific Meeting in 2004 and were published in the
AmericanJournalofMedicinein2005.
2
These studies suggested that thisnewapproach may be the most powerful
nutritional plan ever devised for diabetes. We can do more than try to
compensate for malfunctioning insulin, as doctors have done for decades with
variousmedications.Rather,wecanhelpthebody’sowninsulinworkproperly
againbydirectlyaddressing—andimproving—thecells’sensitivitytoit,which
is the key issue in type 2 diabetes. Even when the disease has evolved to the
point of serious complications, it is not too late for marked improvements to
occur.
Starting in 2003, with the support of the National Institutes of Health, we
conducted a new research trial to compare our diet, head-to-head, against the
guidelines promulgated by the American Diabetes Association at that time.
Theseconventionalguidelinesseemedsensibleandwerewellaccepted.Millions
ofpeople followed them,carefully cuttingcalories andlimiting carbohydrates.
But all too often, a familiar story ensued: Despite everyone’s best efforts, the
diseasetypicallyworsenedovertime.Ourgoalwastoseeifwecouldimprove
things. The study was conducted with George Washington University and the
University of Toronto and included 99 individuals with type 2 diabetes. The
participantswererandomlyassignedtoeitherastandarddiabeticdietbasedon
the 2003 ADA guidelines or to the more aggressive diet you will learn about
shortly. Along the way, I presented the study’s initial results at scientific
meetingsoftheADA,theAmericanAssociationofDiabetesEducators,andthe
AmericanPublicHealthAssociation.
In a careful analysis that kept exercise and medication use constant, we
foundthatthenewdietcontrolledbloodsugarthreetimesmoreeffectivelythan
theprevious“best”diet.Italsoacceleratesweightlossandcontrolledcholesterol
betterthantheoldgoldstandard.Otherinvestigatorshaveshowedthatthiskind
ofdietalsohasdramaticbenefitsfortheheartandleadstoabigimprovementin
bloodpressure.Itallowsmanyindividualstotakechargeoftheirlivesagainand
toreturntohealthandvigor.
WethenrantwostudieswithGEICO,theinsurancecompany,toseehowit
wouldapplyintheworksettingin10differentcities.Inaword,itworksgreat
and is easy to implement. We have also documented its efficacy against more
advanceddiabetes,focusingonimprovementsinnervesymptoms.
This book translates these scientific breakthroughs into tools that you can
use,includinganeasy-to-followplanwithsimpledietguidelines.
ANEWUNDERSTANDINGOFTYPE1DIABETES
Type 1 diabetes is much less common than type 2. It is usually diagnosed in
childhood and is invariably treated with insulin—hence its former names,
childhood-onsetdiabetesandinsulin-dependent-diabetes.
Unlike peoplewith type 2 diabetes, thosewith type 1 always needto take
insulin.Buttheycanusedietandlifestylechangestokeepdosestoaminimum
andreducetheriskofcomplications.Wealsohaveanewunderstandingofthe
fundamental causes of type 1 diabetes. It may surprise you to learn that the
process that leads to type 1 diabetes begins when the body’s immune system
attackstheinsulin-producingcellsofthepancreas.Asyouwillsee,newresearch
hasrevealedwhatappearstosparkthisattackandwhatcanhelptopreventit.
PERSONALSUCCESS
Let’s take a look at the experiences of real people who followed the program
describedinthisbook.
Nancy
Nancy learned about our research study from an advertisement in the
WashingtonPost.Shehadbeendiagnosedwithtype2diabetes8yearsearlier.A
cousinofhershadlostsomeofhiseyesighttothedisease,andfailedkidneysleft
himondialysis.Nancydidnotwantthattobeherfuture.Shewasgoingtofight
back.
Beforeshe joinedour study, thingshadbeengoingin thewrong direction.
Although she had followed a diet designed for diabetes, her blood sugar was
graduallyworsening,andthedietdidnothingtostopherweightfromcreeping
upward.
Two years after her diagnosis, her doctor put her on her first diabetes
medication. Eventually, her doctor felt she needed two medications. Still her
bloodglucoselevelcontinuedtorise.Assheenteredourstudy,herhemoglobin
A1Clevel—thekeyindexofbloodglucosecontrol,whichoughttobebelow7.0
percent—wasanunhealthy8.3percent.
Nancyjoined thestudybecause sheliked thefocuson foodrather thanon
drugs.Withtheexplosionofdiabetesinthepopulation,sheintuitivelyfeltthat
theproblemhadtobethekindsoffoodweeatandthatthesolutionhadtobe
there,too.
Weshowedherhowtochangeherdiet.Therewerenolimitsonhowmuch
she could eat or on how many calories or grams of carbohydrates she could
have.Butwedidaskhertomakeamajorchangeinthetypeoffoodshechose.
Atfirst,wealsoaskedhernottoexercise—thatis,nottochangeherexercise
habits—becausewewantedtoseewhatdietchangesalonecoulddo.Thatsuited
her just fine—she was very busyather office, working long hoursevery day,
andexercisewasnotexactlyherthing.Atleastnotyet.
As she began to follow our recommendations, her weight started to fall,
along with her blood glucose, the latter with surprising speed. After years of
goingupandupandup,thetrendstartedtoreverse.After11weeks,shestood
onthescale:Shehadlost14pounds.Andwhensherolleduphersleeveandwe
checkedherA1C,wefoundthatithaddroppedfrom8.3percentto6.9percent.
Allinabout3months’time.Herinsulinsensitivitywasreturning.
Nancy’sbloodsugarcontinuedtofall.Infact,itfellsomuchthatitbecame
clearthathermedicationswerenowtoostrongforher.Thecombinationofthe
drugsshehadbeentaking,alongwiththenew,powerfuldietchanges,actually
leftherbloodsugartoolow.Itwastimetoreducehermedications.Butaswecut
backonherdoses,itturnedoutnottobeenough.Afterseveralmoremonths,we
hadtostoponeofthemaltogether.
Alittlemorethanayearafterjoiningthestudy,shewas40poundslighter.
She stopped her diabetes medications, and yet her A1C is better than it was
before—6.8percentatherlasttest.
“Thepayoff is justincredible,” shesaid. “But it’snot just theweight loss.
Mynumbershavegottendramaticallybetter.”
Andtherewasmore—anotherbenefitshehadnotanticipated.Foryears,she
hadhadarthritispainsosevereshecouldnotopenajar.Afterafewmonthsofa
new diet, she suddenly realized that her arthritis symptoms were completely
gone. (There is actually a fascinating body of scientific literature on diet and
arthritis,which I summarizedin an earlierbook, Foods That Fight Pain.)The
bestpartofthestory:Nancy’s experienceisnot unusualfor peoplewho make
thedietchangesyouwillreadaboutshortly.
Vance
Vancewasjust31yearsoldwhenhewasdiagnosedwithdiabetes.Hehadjust
changedtoanewdoctor,andthediagnosiscameafteraroutinebloodtest.Both
ofhismothersparentshad hadthedisease,butup untilthatpoint, Vancehad
beeninmoreorlessgoodhealth.Hehadbeenapoliceofficerfor12yearsand
nowworkedinabank,andhewasnotinthehabitofcallinginsick.
Diabeteschangedeverything.“IfIdidn’tlosealegorgoblind,Icouldend
upondialysis,”hesaid.Andthetruthwas,hewasnotinsuchperfectshape.He
had gradually gained weight over the years, and at just under 6 feet tall, he
weighed276pounds.“Ididn’treallytakemydietormyhealthveryseriously,”
he said. “I grew up on steak sandwiches, pork chops, and chicken. We had
barbecuesandcookouts.Wehadsomevegetables,butnotalotoffreshfoods.I
didn’texercise.Ijustdidn’ttakeanyofthisveryseriously.”
Along with weight problems came difficulties with sexual performance.
Impotence affects many men with diabetes and is common in men who are
overweight. His doctor started him on metformin, a commonly prescribed
medicationforreducingbloodsugar.
Vancelearnedaboutourresearchstudyanddecidedtovolunteer—despitea
few misgivings about the prospect of changing his diet. “I never had any diet
restrictionsorrulesbefore,”hesaid.“Inevertriedtocontrolmydietbefore.I
always ate whatever I wanted.” But his wife had been a vegetarian for some
time,andshewasexcitedthatVancewasreadyforachange,too.
Thepayoffcameprettyquickly.Hisweightstartedtofall,andoverayears
time,helost—tohissurprise—about60pounds.HisA1C,whichhadbeen9.5
percent at the beginning of the study, fell to 7.1 percent after just 2 months.
Fourteen monthsinto the study,it had dropped to 5.3 percent.His doctor was
thrilledandsaiditwastimetostopthemetformin.
One more surprise: His problems with sexual performance virtually
disappearedwithin3months.“Ihaven’tbeeninthisgoodshapesinceIwasin
thepoliceacademy.Itislikeaweighthasbeenliftedoffofme,”hesaid.“When
I toldmy mother what Iwas doing—that Ihadchanged my diet—shewas so
happy,shenearlycried,becausemydaddiedat30.Whenmygrandfatherdied,I
wastheoldestmaleinmyimmediatefamily.Wetendtocheckoutprettyquick.
ButshesawIwasonadifferentpath.Iwastakingcareofmyself.”
SUCCESS
Assoonasthefirsteditionofthisbookappeared,webegantohearfrommany
more people who were putting this method to use and achieving surprising
results.AreaderinEnglandsentthismessage:
I was diagnosed with type 2 last September and was given the
standarddiet/lifestyleadvicebymydoctorandhiscolleaguesherein
theUK.Initiallymydiabeteswasmildandwasmanagedsimplywith
diet/exercise. With time, however, there was deterioration, requiring
strongerandstrongermedication,andIbegantoexperiencetheearly
stagesoftypicaldiabetescomplications.IwasgivenacopyofNeal’s
bookbyacaringandconcernedfriend.Iwasskepticalatfirstbecause
allthe(difficulttomaintain)dietchangesIhadmadetothatpointdid
not seem to be of any use in tackling the problem. However, I
embraced the plan in the book and really began to enjoy eating the
foodsrecommended.
Three months after starting out on Neal’s diet, I have had my
second(sincediagnosis)review.Iwascalledintothedoctorsofficeat
veryshortnoticewithnoexplanationgivenbytheadministratoronthe
phone,justbeingtoldthat“weneedtoseeyoutodaytodiscussyour
blood results from last week.” Obviously I was anxious, to say the
least,andwasquiteworriedjustwhatbadnewsthedocwasgoingto
deliver.ThedoctorcalledmeinhowevertoaskmewhatIwasdoing
because “your blood picture is now more normal than mine, and I
don’thavediabetes.”Hethensaid“Ican’ttellyouthatyounolonger
havediabetesbecausethereisnocurefordiabetes,buttechnically,you
don’t.”
Mydoctorwasshockedatmybloodnumbers;hesaidthatthemost
improvementhehaseverseenuptothatpointwastypicallynomore
than5to10percentinhisbest-manageddiabetespatients.Myblood
numberswereapparentlymorethan60percentbetterthanmylastset
ofresultsinJanuary(beforeI startedNeal’s diet).Mydoctor isnow
recommendingNeal’sdiettohisotherpatientswithdiabetes.
Anotherreader,Patricia,wasworkingasadefenseanalystatthePentagon.
Formostofherlife,shehadstruggledwithherweight,andeventuallyshewas
95poundsheavierthanshewantedtobe.Atage58,shedevelopeddiabetesand
hadblockedarteriesinherheart.Shewasmakingtripstodoctors’officesmuch
moreoftenthanshewouldhavelikedandwastaking13pillsandtwoshotsa
day.
But she learned about our approach and put it to work. Patricia ended up
losing95pounds.Shegotoffallherdiabetesmedications.Shehasmoreenergy
thanshehashadinyears.Herhusbandfollowedherlead,andheslimmeddown,
too.Theyaredoingthingstheycouldn’tdobefore,andtheyfeelgreat.
AwomaninPortlandwrotethatshehadstartedgainingweightafterthebirth
ofhersecondchild.Sheworkedeveningsatacatalogcallcenter,andwhenshe
got off work, she found herself at the drive-thru on the way home, ordering
unhealthythingsandmorefoodthansheneeded.Overtime,shegainedalmost
100pounds.
Thatextraweighttookarealtoll,anditgraduallyrobbedherofthingsshe
lovedtodo.Oneyear,herfamilywenttoDisneyland,andshefoundthatshewas
reallynotabletowalkaroundthevarioussights.Shehadnoenergy,andherfeet
hurt.Afterahalf-hour,shewaspooped,andshehadtoleave.
Oneday,theoccupationalnurseatworkcalledherurgentlytoletherknow
the resultsof some blood testsshe had had. Herfasting blood sugar was278,
whichlookedlikeout-of-controldiabetes.
Thiswasamajorwake-upcall.Shewasnotjustheavy;shewasintrouble.
Well,shefoundinformationfrommyteamabouttacklingweightproblems
anddiabetes.Ourmethodfocusedonfoodandallowedhertoeatasmuchasshe
wanted,zeroing inonthe typeoffood sheate. Thatsounded reallyappealing,
andshejumpedin.
Inthefirst3weeks,shelost7pounds,andherbloodsugarwasstartingto
fall,too.Afterayear,shewasdown60pounds.Andtodaysheisattheweight
shewantstobe.
Andwhataboutherdiabetes?Well,herA1Cbloodtestwas10.1whenshe
started—that’s way into the diabetic range. But it gradually came down and
down and down, and today it is well below the diabetic range. And her
cholesterolplummeted63points.
And her energy is back. Remember the problems she had trying to walk
aroundDisneyland?Well,todaysheisonherfeetforhoursatatime,running
trainingcoursesfornewemployees.Andshehasenergytoburn.
Herskinusedtobeblotchyandred.Andnowit’sbacktothewayitshould
be.Headaches,stomachaches,andpainsinherfeethaveallgoneaway,andshe
feelsgreat.
Shehastakencontrol,sheddingthatweightandgettingherenergyback.And
sheloveseatinghealthfulfoodsthatworkforher,notagainsther.
There are many, many more stories ofgreat success from real people. But
nowisthetimeforyoutobeginyourownsuccessstory.
TAKINGCONTROL
ThedietembracedbyNancy,Vance,andtheothersyouhavereadabouthere—
and that I hope you are about to begin—is designed to do much more than
simply palliate diabetes, as other diets do. It is designed to tackle the
fundamentalcausesofthedisease.
Asthosewhoparticipatedinourstudylearned,bloodsugarlevelsthatcreep
steadilyupwardcanalsofall.Theroadtodiabetesisinfactatwo-waystreet.
Whetheryouhavetype2diabetesandwanttogaincontrolofyourhealthor
havetype1diabetesandneedtoreducethedisease’sintrusiononyourlife,this
programwasdesignedwithyouinmind.
However, our research—and this book—also targets a broader purpose.
Moreandmorepeople,includingasurprisingnumberofchildren,arediagnosed
withdiabeteseveryday.Theyandtheirfamiliespayahighpersonalpricewith
the condition. And clinics, health maintenance organizations, insurers, and
governmentprograms arestruggling tokeep upwith prescriptioncosts, doctor
visits,andhospitalizationchargesforitsmanycomplications.Formanypeople
atrisk,itissimplyamatteroftimebeforetheyarediagnosed.Itisourhopethat
anewdirection indietandnutrition,if appliedbroadlyenough,can goalong
waytowardsolvingtheseproblems.
Thisprogramistrulyarevolutioninthewaywethinkaboutthisotherwise
unforgivingdisease.Diabetes isnolongera conditionyousimply havetolive
with.Itneednotslowlyandinevitablygetworse.Quitetheopposite.Ifyouhave
diabetes,itistimeforyoutogetyourlifeback.
Wewillnotcatertoyourdiabetes.Rather,thisprogramisdesignedtohelp
youunderstandthecauseofdiabetesandhowtocorrectittothefullestextent
thatdietandlifestylechangespossiblycan.Ifyoudonothavethediseasebut
areatrisk,thisisapowerfulprogramforpreventingit.
“Is this program for me?” you may be asking. The answer is an emphatic
yes.Here’swhy.
Whetheryouliketocookorprefertoeatatrestaurants,youcaneasily
make the diet changes you need. I make this point because some people
imagine that changing their diet means making every meal in their own
kitchens.Translation:hoursandhoursofwork.Ifyouinwardlygroanatthat
thought,Icertainlysympathize:Ilearnedlongagothatmytemperamentis
notsuitedtospendingmuchtimeinthekitchen.PerhapsIwasbornwiththe
“roomservicegene,”andmaybeyouwere,too.SoIwillshowyouhowto
planahealthfulmenuandhowtomakeitworkforyouwhetherornotyou
liketocook.Manyofourresearchparticipantstravel,eatatrestaurants,or
eat in theircompany cafeterias. This program worked for them,and it can
workforyou.
Itdoesnotmatterwhetheryouloveexerciseorhaveneverbeenableto
stickwithanexerciseplan.Theimprovementsdescribedaboveweremade
withoutexercise.Infact,ourresearchstudiestypicallyomitexercisebecause
weneedtoisolatetheeffectofdietchangesinordertoputthemtoagood
test.Havingsaidthat,exerciseisanimportantpartofanydiabetestreatment
regimen, and this book will show you how to bring it into your life in a
sensible, safe, and effective way. If, however, you are unable to engage in
significant exercise because of joint problems, a heart condition, or severe
obesity,orifyoufindyou’rejustnotabletostickwithanexerciseprogram,
you will be glad to know that the benefits of our diet change are not
dependentonanyalterationofyouractivitylevels.
If you have felt that you just cannot stick with a diet, I completely
understand. That’s why we will focus solely on what you eat, not how
much.Youcaneatuntilyouarefullandhavesnackswhenyouwantthem.
You will have to invest some energy, however: You will have to learn to
think about food in new ways. And you will have to unlearn some old,
outdatednotions.Andifyouhavebeenoverweight,itisverylikelythatyou
willhavetobuysomenewclothes!
WHATDOESITMEANTOREVERSEDIABETES?
Mostpeoplewithdiabetes findthemselveson aroadleading towardgradually
increasingweight, slowlyrising bloodsugar, higherdoses ofmedications, and
worsening complications. Reversing diabetes means reversing this trend. If
weightisanissue,itcancomedown—gradually,butdecisively.Bloodglucose
valuesthathavegoneupcanalsocomedown.Dosesofmedicationsthathave
risen again and again can come down, too. Symptoms such as neuropathy—
nervepaininthefeetandlegs—canimproveandevendisappear.Heartdisease
canbereversed.
Will the disease go awaycompletely? Some people wouldarguethatonce
someone has diabetes, that person will always have it, even if blood tests
improvesomuchthattheconditionisnolongerdiagnosable.Whattheymeanis
that the genetic traits that made type 2 diabetes possible do not go away, and
type1diabetesrequirescontinuedinsulintreatmentsregardlessofhowwellyou
adjustyourdiet.
Itisnotpossibletosayinadvancehowfaryoucango.Willyoubeableto
reduce your medication doses, eliminate some or perhaps all of your
medications,ordriveyourbloodsugardownsofarthatnoonewouldeverknow
you oncehad diabetes?These are questionsyour own experiencewill answer,
butIcanpromisethisbookwillteachyouwhatyouneedtoknowaboutputting
apowerfulfoodprescriptiontowork.Therestofthestoryisyourstowrite.
Iwould bevery gratefulif youwould letothers knowwhat youare doing
and perhaps lend this book to your friends or family members who have
diabetes. We know that we can turn this disease around for individuals, but
conqueringaninternationalepidemicisatallorder,anditrequiresateameffort.
I hope you will join in this important cause along with health professionals,
researchparticipants,andtheirfamilies.
Thankyou,andtheverybestofluckwiththisprogram.
PART1
TheBreakthrough
CHAPTER1
TheNewBasics
In recent years, much of what we thought we knew about diabetes has been
turned on its head. What is now coming into focus is an understanding of its
fundamentalcauses,andthatgivesuspowerweneverhadbefore.
Tomakesureweareatthesamestartingpoint,letmewalkyouthroughthe
basics: symptoms, diabetes types, and typical treatments as they are currently
used.ThenIwillshowyouwhat’snew.
HOWDOWEKNOWIT’SDIABETES?
First,let’smakesenseofthesymptoms.Diabetesmayarrivewithnosymptoms
atall,butoftenitstartswithfatigue.Fornoapparentreason,yoursparkisjust
no longerthere. It may alsoseem that youarelosing water morerapidly than
youshouldbe,whichistosaythatyoumaketripstothebathroommoreoften
thanusual.Andyouarethirsty:Youfindyourselfdrinkingasurprisingamount
ofwater.
Hereiswhatisgoingon:Thefundamentalproblemisthatsugarisnotable
to pass from your bloodstream into the cells of your body. From that single
problemcomeagreatmanyothers,likeonedominoknockingoveranotherand
anotherandanother.
Thesugarwearespeakingofisglucose—oneofthesmallestandsimplest
sugar molecules. In this case, sugar is not just another word for junk food or
emptycalories.Thefactisthatthecellsofyourbodyusethiskindofsugar—
glucose—as an energy source. Like gasoline for your car or jet fuel for an
airplane,glucoseisyourbody’sfuel.Itpowersyourmovements,yourthoughts,
andmoreorlesseverythingyoudo.
Andthatisexactlytheproblem.Ifglucoseisunabletoenteryourcells,they
are deprivedof their basic fuel, soyoulose your energy. That iswhy you are
fatigued.Ifyourmusclesdonothavetheglucosetheyneedforpower,youtire
easily.
Meanwhile,theglucose thatcannotgetintoyour musclecellsbuilds upin
your bloodstream. It becomes more and more concentrated in the blood, and
eventuallyitstartstopassthroughthekidneysandendsupinyoururine.
*
Now,asglucosepassesthroughyourkidneys,itcarrieswateralongwithit—
lotsofwater, henceallthosetrips tothebathroom.What follows,naturally, is
thirst—youarelosingallthosefluids.Sofatigue,frequenturination,andthirst
are all symptoms of one problem: glucose is having trouble getting into your
cells.
You may also find that you are losing weight. And no, this is not an
especiallywelcomeevent—notinthis situation.You loseweight becauseyour
cellsareinessencestarving.Nutrientscannotenteryourcells,soyourbodyis
malnourished.Yes,evenifyouareeatingplentyoffood,nutrientsandfuelare
unabletogetwheretheyareneeded.
Everyday,peoplearriveatdoctors’officescomplainingoffatigue,frequent
urination, thirst, and sometimes unexplained weight loss. The doctor takes a
blood sample, finds an unusually high level of glucose in the blood, and
diagnosesdiabetes.Thedoctorthenadvisesthepatientthatitisessentialtoget
bloodsugarundercontrol.Anoverlylargeamountofglucosefloodingthrough
the bloodstream day after day can harm the arteries. Left unchecked, it can
damage the heart and the delicate blood vessels of the eyes, kidneys, and
extremities.
Butaswehaveshowninourresearchstudies,theroadtohighbloodsugaris
a two-way street. When you change your diet and make other healthful
improvements,arisingglucoselevelcanfall.Sometimesthechangecanbeso
dramaticthatnodoctorlookingatyouafterwardwouldeverguessthatyouhad
oncebeendiagnosedwithdiabetes.
HowDoctorsDiagnoseDiabetes
Doctorsdiagnosediabetesif:
Yourbloodglucoselevelis126mg/dl(7.0mmol/l)*orhigherafteran8-hourfast.
Your blood glucose is 200 mg/dl (11.1 mmol/l) or higher after a 2-hour glucose tolerance
test. This is a test in which you drink a syrup containing 75 grams of glucose, and your
bloodglucosevalueismeasured.
Your A1Cblood test is6.5 percent orhigher. A1C is atest that reflectsyour blood sugar
controloverthepreceding3 months or so, unlikeabloodglucose test, which will tendto
rise and fall from minute to minute under the influence of foods, physical activity,
medications,stress,andotherfactors.WhattheA1Ctestactuallymeasuresishowmuch
glucosehasenteredyourredbloodcellsandbecomestucktohemoglobin.Ifyouhavehad
a lot of glucose in your blood, a fair amount of it gets into your cells and sticks to your
hemoglobin.
*USmedicallaboratoriesmeasureglucoseinmilligramsperdeciliter(mg/dl).Inmostother
countries,glucoseismeasuredinmillimolesperliter(mmol/l).Asyouwillsee,thesame
unitsareusedincholesterolmeasurements.
DiabetesTypes
Adiagnosisofdiabetes—orprediabetes—meanstheinsulininyourbodyisnot
doing its job adequately. Insulin is a hormone that moves sugar from your
bloodstreamintothecellsofyourbody,amongotherfunctions.Itactslikeakey,
opening a door to the cell, so to speak, and allowing nutrients inside. When
insulinarrivesatthecell’ssurfaceandopensthedoor,glucoseisabletoenter
thecell,whichusesitforpower.
Ifforsomereasonyourbodyisnotmakinginsulin,theresultisrisingblood
glucose levels. Similarly, your blood glucose rises if your cells resist insulin’s
actions—thekeygoesinthelock,butthedoorwillnotopen.
Diabetes comes in three main types, called type 1, type 2, and gestational
diabetes, plus some variants you may need to know about. Let’s look at each
one.
Type1diabetesusuallymanifestsinchildhoodoryoungadulthood.Itused
to be called childhood-onset or insulin-dependent diabetes. In type 1 diabetes,
somethinghasdamagedthepancreas’sabilitytoproduceinsulin,andyouneed
togetitfromanoutsidesource—typicallybyinjection.However,researchhas
revealedagreat dealabout how dietchanges can reducethe risk thatdiabetes
willbringanyseriouscomplicationsyourway,asyouwillseeinChapter3.
Inaddition,weknowmorethaneveraboutthecausesofthedisease,arming
uswithmorepowertopreventit.Thedamagetotheinsulin-producingcellsis
causedbythebiologicalequivalentof“friendlyfire.”Thatis,itiscausedbythe
body’simmunesystem—ourwhitebloodcellsthataresupposedtofightbacteria
andviruses.Thesecellsoughttoprotectyou,butinsteadtheyhaveattackedthe
cellsofthepancreas,destroyingitsabilitytoproduceinsulin.InChapter3,we
willlookatwhattriggersthisprocess.Itmaysurpriseyoutolearnthatfoods—
particularlythefoodsinfantsarefedwithinthefirstmonthsoflife—areleading
suspects.
Whentype1diabetesmanifestsinpeoplewhoarebeyondearlyadulthood,
thetermlatentautoimmunediabetesofadults(LADA)issometimesused.But
thediseaseisstilltype1diabetes.
Type2diabetes used tobe called adult-onset diabetes,or sometimes non-
insulin-dependentdiabetes.About9outof10peoplewithdiabeteshavetype2.
Mostpeople withthisform ofthe diseasestillproduce insulin;theproblem is
thattheircellsresistit.Insulintriestobringglucoseintothecells,butthecells
respond like a door with a malfunctioning lock. In response to these sluggish
cells, your body produces more and more insulin, trying to overcome the
resistance.Ifthebody’sinsulinsupplycannotovercometheresistance,glucose
simplybuildsupinyourblood.
Diabetesdrugsworktocounteractthisproblem:Somemakeyourcellsmore
responsivetoinsulin.Otherscauseyourpancreastoreleasemoreinsulinintothe
bloodstreamorblockyourliverfromsendingextraglucoseintotheblood.
Until now, most diabetes diets have tried to compensate for the cells’
resistancetoinsulin’saction,too.Theylimitedtheamountofsugarinyourdiet.
Theyhavealsolimitedstarch(complexcarbohydrate)becausestarchisactually
madefrommanyglucosemoleculesjoinedtogetherinachain.Duringdigestion,
starchbreaks downto releasenatural sugarsinto theblood. Theidea isthat if
you do not gettoo much carbohydrate at any one time, your cells will not be
overwhelmed with too much glucose. For people on medications, typical diet
planshaveaimedtokeeptheamountofsugarorstarchfairlyconstantfrommeal
tomealandfromdaytodaysotheamountofmedicationrequiredtohelpyour
body process glucose—your daily dosage—can stay the same, too. In short,
thesedietshaveguidedyouonwhat,when,andhowmuchtoeat.
New research has changed everything, however. We can now use diet
changestoinfluenceinsulinsensitivitydirectly.So,asyouwillseeshortly,the
nutrition prescription has been completely rewritten to take advantage of this
newunderstanding.
Gestational diabetes is similar to type 2 except that it occurs during
pregnancy. While it typically disappears after childbirth, it is a sign of insulin
resistance,andthatmeansthattype2diabetesmaybearoundthecorner.With
thesamesortsofstepsthattackletype2diabetes,wecanoftenstopgestational
diabetesfromeverturningintotype2.
Maturity Onset Diabetes of the Young (MODY). Rarely, a genetic
characteristiccancausethepancreastoproduceinsufficientinsulin.Thegeneis
typicallydominant.Theaffectedindividualisverylikelytodevelophighblood
sugars,even thoughhe orshe maynotbe overweightor haveinsulin-resistant
cells.Becausethepancreascontinuestoproducesomeinsulin,insulininjections
maynotbeneeded.Thetreatmentissimilartotype2.
Prediabetesisthetermusedwhen yourblood glucoselevel ishigher than
normal, but not high enough for a diagnosis of diabetes. For most people, it
meansthatyouhaveinsulinresistanceandareonyourwaytodevelopingtype2
diabetes,unlessyoutakestepsnowtoimproveyourhealth,especiallythrough
changesinyoureatinghabits.Thistermapplieswhen:
Yourfastingbloodglucoselevelisbetween100and125mg/dl(between5.6
and6.9mmol/l).
Your blood glucose is between 140 and 199 mg/dl (between 7.8 and 11.1
mmol/l)aftera2-hourglucosetolerancetest.
YourA1Cbloodtestisbetween5.7and6.4percent.
Thegoodnewsisthatthesamestepsthathelppeopletackletype2diabetes
are also effective for helping people with prediabetes to improve, often
decisively.
Insulinismadeinthepancreas,anorganlocatedjustbehindyourstomachthatisaboutthesize
and shape of a TV remote control. In fact, remote control is what the pancreas is all about. It
sendsinsulinintothebloodstreamtotraveltothecellsofyourbodytohelpthemtakeinglucose
fromthebloodstream.Intype1diabetes,thepancreashasstoppedmakinginsulin.Intype2and
gestationaldiabetes, the pancreasis usuallyabletomakeinsulin,but the body’scellsresistits
action.
GENESARENOTDESTINY
Diabetesrunsinfamilies,butdon’ttakethattomeanthatifoneofyourparents
has diabetes, a similar diagnosis has to be your fate as well. You can change
things.
Let’stakealookattype1diabetesfirst.Manychildrenarebornwithgenes
thatmakeitpossibleforthemtodeveloptype1diabetes,butmostofthemnever
do.Infact,evenamongidenticaltwins,whenonetwinhastype1diabetes,the
otherhaslessthana40percentchanceofhavingit.
1
Whatmakesthedifference,
apparently, is the environment, particularly the foods the child is exposed to
earlyinlife(e.g.,cow’smilk);viralinfections;andperhapsotherfactors.
Genesplayasimilarroleintype2diabetes.Manyyearsbeforediabetesever
manifests, special tests can detectinsulin resistance in young adults who have
inherited a tendency towardtype2 diabetes from their parents. If they eat the
samekindsoffoodstheirparentsdid,theyareverylikelyheadedforadiagnosis.
Abundantevidenceshows,however,thatchangesindietandlifestylecancutthe
oddsthatdiabeteswilloccur.Whenitdoesoccur,dietcandramaticallyalterits
course.
Thepointisthis:Somegenesaredictators,andothersarenot.Thegenesfor
haircolororeyecolor,forexample,reallyaredictators.Iftheycallforyouto
have brown hair or blue eyes, you can’t argue. But the genes for diabetes are
morelikecommittees.Theydonotgiveorders;theymakesuggestions.
Ifourgenescallfordiabetes,wedonotnecessarilyhavetolistentothem.
Wehavemorecontrolthanyoumightimagine.
EATINGPATTERNSFORDIABETES
Ifyouhavediabetes,chancesareyouweregivenprintedguidelinesonwhatto
eatandwhattoavoid.Perhapsyouhavemetwithadietitian,andyoumayhave
been referred to a diabetes class. If you are like many people, you may have
foundyourdiettoughtosustain.
For many years, diets for people with diabetes were designed to provide
basic nutrition while also keeping calorie intake and food choices reasonably
stableoverthecourseofthedayandfromonedaytothenext,asyousawabove.
Theideawasthatifyouhadnocarbohydratesforbreakfastbutthenhadabig
carb-festlaterintheday,yourbloodsugarwouldchangeerratically.Similarly,if
youhadlotsofstarchyfoodsonMondaybutwentlow-carbtherestoftheweek,
your blood sugar would be all over the map, and your medications could not
keepupwithyou.
Thatapproachsoundslogical,butitwasdevisedbeforethecausesofinsulin
resistancewereknownandhasturnedouttobeoflimitedvalue.Manypeople
have trouble sticking with it. Now that we understand more about what is
happening inside your cells to cause diabetes, we can choose foods more
strategically.Thatmeansdietchangesthataresimplerandmoreeffective,asyou
willseeinthefollowingchapters.
The American Diabetes Association now gives a thumbs-up to several
different eating patterns, including vegetarian and vegan diets, the semi-
vegetarian “DASH diet,” low-fat diets, low-carbohydrate diets, and
“Mediterranean diets.” However, we now have good scientific evidence that
allowsustoseewhichdietchangesreallyworkbestoverthelongrun,andsoon
youwillbeputtingthatpowertowork.
DRUGSANDMONEY
Thedietchangesyouwillreadaboutinthisbookarepowerful.Unfortunately,
thepowerofnutritionisneglectedinmanymedicalpractices,andintheprocess,
diabetestreatmentisreducedtoaseriesofprescriptions.
Don’tmisunderstandme.Diabetesmedicationscanbelifesaving.Theycan
reduceyourbloodsugarand,overthelongrun,cutyourriskofcomplications.
Andifdietandlifestylechangesdonotdothejob,itcanbeaseriousmistaketo
forgomedications.Butsomedoctorsandpatientsviewmedicationsastheonly
tools at their disposal. The marketing of pharmaceuticals has so dominated
medicalpracticethatmanydoctorsgivelittlemorethanlipservicetodietand
exercise,whichcanoftenbedramaticallyeffective.
Openanydiabetesjournalandyouwillseeexpensiveadvertisementsforthis
drugandthatdrug.
Ifyouweretoleafthroughthemailthatfloodsdoctors’offices,youwould
see information about medical courses, symposia, and online educational
programs, all paid for by drug companies trumpeting their products. These
companiescaterfulldinnerstoluredoctorstopresentationsaboutoneoranother
applicationoftheirdrugs.Whilemanydoctorsfindsucheventsdistasteful,they
are required to attend medical courses to maintain their hospital or university
affiliations,anddrugcompanieshavecorneredthemedicaleducationmarket.
At the ADA annual meeting, drug company representatives arrive at the
loading dock looking as if they are preparing to put on an enormous political
convention. They erect huge display booths costing hundreds of thousands of
dollars staffed with armies of sales personnel ready to provide gifts, food,
musical entertainment, and trinkets of all kinds, all designed to woo the
cliniciansinattendance.
And, of course, drug companies target consumers directly. Turn on a
televisioninanyAmericancity,andyouwillsoonbeinundatedbycommercials
asking you to speak with your doctor about all manner of medications. They
make diabetes sound almost like fun, and their latest products add to your
modernlifestyle.
You,thedrugconsumer,arestuckwiththebillforallthis.Atypicaldiabetes
pillcontainsafewcents’worthofactivemedication,buttheretailcostisheavily
inflatedbyitsmanufacturerspromotionalexpensesanditscontinuedeffortsto
findyetanotherpillthatcancarveoutmoreofthemarketshare.
Thediabetes businessis notlimitedto drugs.Patients needtobuy glucose
testing equipment, too. While glucose meters are not terribly expensive,
manufacturerschargeasmallfortuneforthesuppliesthatgowiththem,much
liketheshaving-productcompaniesthatgiveawayfreerazorstosellexpensive
blades.Theteststripsthatfitintoatypicalglucosemetercostabout$1each,and
apersonmightuseanywherefromonetoeightstripsperday.Addupthecosts
ofdoctorvisits,laboratorytests,medication,andglucosemonitoringequipment,
anddiabetesbecomesaphenomenallyexpensivedisease.
It is my hope that as the power of nutritional changes is more fully
appreciated, the commercial aspects of diabetes will take a backseat. The US
government has already invested in research on diet and diabetes, and that
investment will continue to pay important dividends. We must also turn our
attentiontoputting whatwehavelearnedabout nutritiontowork. Thatmeans
encouraging doctors to focus on diet first, pushing insurers to cover dietetic
counseling for patients and their families, educating parents about nutritional
approachestohelp preventtype1 diabetesintheirchildren, andworkingwith
schools to serve healthful meals so children are not sent down the road to
overweight anddiabetes, as a great manycurrently are. These measurescould
controltheso-calleddiseasesofaffluencefarmoreeffectivelythandoctorsare
able to at present, dramatically reducing the need for medications in the first
place.
Eachpersonwithdiabeteshasauniqueabilitytohealandreturntohealth.
Thisabilitydiffersfromonepersontothenext,butinourstudies,wehavenot
seenage,weight,oranyotherfactortobeabarriertoimprovement.
The remainder of this book will show you what I believe to be the most
powerfuldietaryapproachtodiabetesthatiscurrentlyknown.
*
Thepassageofglucosefromthebloodstreamintotheurineledtothetechnicalnamedoctorsusefor
diabetes:diabetesmellitus.DiabetescomesfromaGreekwordmeaning“topassthrough,”andmellitusis
theLatinwordfor“honey”or“sweet.”
CHAPTER2
ReversingType2Diabetes
Remarkably, my research has shown that it is possible to reverse diabetes—to
decreasebloodsugar,medicationdoses,andtheriskofcomplications—andthis
chapterwill show youhow,using surprisingly simplediet changes.I willalso
share some surprising new findings about the causes of type 2 diabetes—
changesinsideyourbody’scellsthatcanbedetectedyearsbeforediabetesstarts.
Evidencesuggeststhatswitchingtoahealthierdiethasapowerfulinfluenceon
theworkingsofyourcells,asyouwillsee.
Alldoctorsanddietitiansrecognizethatifyouhavediabetes,yourbodydoes
not process sugar very well, which is to say that the amount of sugar in your
bloodstreamistoohigh.Researcherslearnedlongagothatifitstayshigh,you
areatriskformanyhealthproblemsdowntheroad.
Toloweryourbloodsugar,mostmedicalprofessionalsarelikelytoprescribe
adietthatincludesverylittlesugar.Theywillalsoaskyoutolimitstarchyfoods
—such as bread, potatoes, rice, and pasta—because in your digestive tract,
starchbreaksaparttoreleasesugar(thatis,glucose).Itseemstomakesense—if
your body cannot handle sugar, you have to be careful about eating too much
sugarandanythingthatturnsintoit.Yourmedicalteamwillalsoencourageyou
to spaceout your intakeof starches and sugarsthroughout the day—and from
onedaytothe next—sothat itstays fairly evenover time.Diabetes diets also
generallycutcaloriestohelpyouloseweightandlimitcertainfatstoreducethe
risk of heart disease and other complications. That, in a nutshell, is a typical
“traditional”diabetesdiet.
Itiscertainlylogical,andsomepeoplegreatlybenefitfromfollowingit.The
problemisthatformostpeople,thissortofdietchangehasonlyaverylimited
effect.Weightlossisusuallymodest,andthedietalonetypicallyisnotenough
tobringbloodsugarundercontrol.
Soonerorlater, youandyourdoctor arelikelytodecide thatthe“diabetes
diet”isnothelpingverymuch,andyourdoctorwilladdvariousdrugs.Youmay
needone,two,oreventhreedifferentoralmedications.Eventually,yourdoctor
mayconsideraddinginsulininjections.Andbecausemanypeoplewithdiabetes
also have high blood pressure or high cholesterol levels, doctors often add
medicationstotackletheseproblems,too.Insteadofhelpingyoureduceoravoid
medications, the diet seems to be a stepping-stone on the way to an ever-
increasinglistofdrugs.
Thefirstglimmerthattheremightbeabetterwaycamefromalookatthe
prevalenceofdiabetesaroundtheworld. Largepopulationstudiesshowed that
diabetes wasrare in Japan,China, Thailand, and otherAsian countries. Itwas
similarlyrareinpartsofAfrica.
These studies also showed something else: People in countries where
diabetes was uncommon were not following anything like a “diabetes diet.”
Theydidnotavoidcarbohydrates;theyatestarchyfoodseveryday.InAsiaand
Africa, rice and other grains, starchy vegetables, bean dishes, and noodles are
staples.Infact,researchersfoundthatpeopleinthesecountriesateconsiderably
more carbohydrates than North Americans or Europeans do, yet diabetes was
relativelyrare.Sowereweightproblems.Whileobesityisfoundinmorethan30
percentofAmericanadults,itoccurredinlessthan1percentofJapaneseadults
followingatraditionaldiet.Heartdiseaseandseveralformsofcancerwererare,
too.LongevityamongJapaneseadultswasbetterthanthatofNorthAmericans
orEuropeans.
That is, until they moved to Vancouver—or Seattle, Chicago, Atlanta, or
Washington,DC. Fora Japanese adult,a moveto NorthAmericadramatically
increasedtheriskofdiabetes.Heartdisease,obesity,andotherproblemsbecame
muchmorecommon,too.
Now, ifyouareworrying thatIamgoing toask youtoadopta traditional
Japanesediet,relax.That’snotabadidea,butitisnotwhatthisbookisabout.I
raise this international comparison simply to make an important point:
Carbohydrates do not cause diabetes. And a diet that focuses on keeping
carbohydrates out of your diet is not a powerful way to manage—let alone
reverse—thedisease.Ifanything,healthycomplexcarbohydrateshelppreventit.
Think about what happens when an Asian man or woman switches to a
Western lifestyle. Hamburgers, fried chicken, cheese, and other Western fare
come into the diet, while rice and noodles are gradually forgotten. The diet
becomes fattier and much higher in protein, while carbohydrate-rich rice and
noodlesandotherstarchyfoodsfallbythewayside.
Tragically, thatis exactlywhat ishappening. What’smore, Asianmen and
womenneednotleavehomeforthesechangestooccur.McDonald’shascome
tothem;BurgerKing,KFC,andotherWesterneatinghabitshavealsoinvaded
Asia.Meat,cheese,andothergreasyfoodsaredisplacingriceandvegetables.
AstheJapanesediethasbecomeWesternized,theprevalenceofdiabeteshas
exploded. In studies of adults in Japan over age 40, diabetes prevalence was
between 1 and 5 percent prior to 1980. By 1990, it had gone up to 11 to 12
percent.
1
Statisticalprojectionssuggestitwillriseevenfurther.Itturnsoutthat
the genes that allow diabetes to occur are surprisingly common among the
Japanese,butaslongastheystucktotheirrice-basedtraditionaldiet,thedisease
wasmostlyheldincheck.Thediabetesgeneslaydormant,likeseedsondrysoil.
Once rice fell out of fashion and Western eating habits took hold, the genetic
traitsstartedtoshowthemselves.
So,ifpeopleinAsiaorAfricawhoeatlotsofcarbohydrateshaveverylittle
diabetes,andifthediseasebecomesmoreandmorecommonascarbohydrates
are excluded from the diet, researchers have had to conclude that a high-
carbohydratedietisnotthecauseofthedisease.Infact,theculpritseemstobe
lurkinginourWesterndiets.
Theinescapablefactisthattheproblemisnotcarbohydrates(thatis,sugar
and starch). The problem is in how the body processes them. If we can repair
your body’s ability to absorb and use carbohydrates, not only can you enjoy
healthy carbohydrate-rich foods without worry, but diabetes itself ought to
improve—perhapsevengoaway.
AlookinsideyourbodywillshowyouwhatImean.
ALOOKINSIDEYOURBODY
Your pancreas, an organ in your abdomen, produces insulin. As you know by
now, insulin is a hormone, and the pancreas sends it into your bloodstreamto
travel to the various cells of the body. Like a key sliding into a lock, insulin
attaches to a receptor on the cell’s surface and causes the cell membrane to
permit glucose to enter. Insulin does the same thing for the next cell, and the
next,andthenext.Itattachestoareceptoronthecell’ssurface,opensthedoor,
andushersglucosein.
Intype2diabetes,thissystemdoesnotworkproperly.Yourpancreasmakes
insulin, and insulin travels to each cell, but when it arrives, it has trouble
openingthedoor.Itisasifthelockhassomehowbecomejammed,andthekey
nolongerworks.Thisisinsulinresistance.Yes,theinsulin“key”isthere,butit
hastroubledoingitsjob.Glucosecannotgetintothecells,anditbuildsupinthe
bloodstream.
Imaginetheworkingsofalockonatypicaldoor.Whatifsomeonewereto
jamchewinggumintothelock?Thereisnothingwrongwithyourkeyandreally
nothingwrong withthelock exceptthatit isnowfilledwithgum.Tomakeit
workagain,weneedtocleanitout.
Thenewapproachtodiabetesisbasedoncleaningoutyourbiologicallocks.
Ourgoalistohelpyourinsulin“key”workthewayitissupposedto.
THENEWDIABETESDIET
Asfarbackastheearly1900s,researcherswereadjustingpeople’sdietstotryto
improve insulin sensitivity.
2, 3
Over the years, many—like me—have been
inspired by the fact that foods that are commonly eaten in Asia or Africa
somehowhelppreventdiabetes.
In1979,researchersattheUniversityofKentuckystudied20menwithtype
2diabetes,allofwhomhadbeentakinganaverageof26unitsofinsulinperday.
The experimental diet included plenty of vegetables, fruits, whole grains, and
beans,soitwashighinfiberandcarbohydrate.Thedietwasnearlyvegetarian,
withverylittleanimalfat—infact,verylittlefatofanykind.
Afterjust16daysontheprogram,morethanhalfofthemenwereableto
stoptakinginsulinentirely,andtheirbloodsugarlevelswerelowerthanbefore.
4
For the remaining men, insulin doses were cut dramatically. That was an
amazingandrapidresult.Butthestudywasshort,andtheparticipantslivedon
theresearchwardforitsduration.Itwasunclearwhetherasimilarresultwould
beseeninpeoplelivingontheirownandpreparingtheirownmealsandwhether
itwouldbesustainedoverthelongterm.
A study conductedatthe University of California, Los Angeles—197men
enrolledina3-weekdietchangeandexerciseprogram—showedmuchthesame
thing.Ofthisgroup,140wereabletodiscontinuetheirmedications.
5
Thatwasa
greatresult,anditoccurredveryquickly.Thestudy’slimitationfromourpoint
ofviewwasthatitcouldnotseparatetheeffectsofdietfromthoseofexercise.
Both are important, of course, but if we want to track down the best diet for
diabetes,itisimportanttokeepeverythingelseconstantwhilethedietisbeing
tested.
Several years ago, my researchteambegan a series of studies to see what
dietalonecoulddo.Wetestedadietthatfocusednotonlimitingcarbohydrates
but rather on getting as much fat off the plate as possible. We thought if we
coulddothat,perhapswecouldcleanoutthe“lock”mechanismthatopensthe
celldoors.
We began with a small pilot study, which I mentioned briefly in the
Introduction. Most of the participants were surprised to see rice, pasta, sweet
potatoes,andbeansonthemenuandevenmoresurprisedthatthedietdidnot
limit carbohydrates at all. No matter how long they had had diabetes or how
nervoustheyfeltabouttheideaofputtingcarbohydratesbackontotheirplates,
weputnolimitoncarbsatall.
There was also no limit on portions. Most of our participants were
overweight,butevenso,wedidnotaskthemtolimitportionsorcutcalories.
Whatwezeroedinonwasfat.Weaimedtocleanallthegreaseoutofthe
participants’ diets. So, instead of bacon and eggs for breakfast, they had to
choose from old-fashioned oatmeal, halfa cantaloupe, or whole grain toast. If
theyhadchiliforlunch,itwasveggiechili.Insteadofpastatoppedwithmeat
sauce,theygotmeatlessmarinara.Forthedurationofthestudy,weaskedthem
tosetasideanimalproductscompletelyandsticktovegetarianfoods.
Needless to say, if there are no animal products in the diet, there is not a
single drop of animal fat. We kept the use of vegetable oils as minimal as
possible, too. And, in order to isolate the effects of the diet, we asked the
participantsnottoaltertheirnormalactivitypatterns;noonewastoaddexercise
totheregimen.Now,exerciseisanimportantpartofanyhealthylifestyle,and
ordinarilywewouldstronglyencourageit.Butthiswasatestofthedietalone,
andforscientificreasons,exercisewasnottobepartofit.
Attheendofthestudyperiod,everyone weighedin.In just12 weeks,the
averageparticipanthadlost16pounds.Theirfastingbloodsugarhaddropped28
percent. Two-thirds of the participants on diabetes medications were able to
reduce or discontinue them in that short period of time.
6
All this occurred
withoutanylimitsoncalories,portions,orcarbohydratesandwithoutexercise.
These effects were significantly greater than those seen in a control group
carefully following the diet guidelines of the American Diabetes Association
(ADA).
Thatwasimpressive.Butwhy didithappen? Howdoes adietthat givesa
green light to pasta, rice, and all the other foods that people with diabetes
thought they had to live without—and one that completely disregards calories
and avoidsexercise—cause bloodsugar to plummetand weightto easily drop
away?
To answer that question, we designed another study. This one included a
groupofwomenwhoweremoderatelyorseverelyoverweightbutdidnothave
diabetes. Once again, we zeroed in on animal fat and vegetable oils. Our
participantssetanimalproductsasideandkeptoilstoabareminimum.Andthey
werefreetoimplementthedietguidelinesintheirownway,whethertheyateat
homeorateout,soitwasagoodtestofhowthedietwouldworkinreallife.For
one person, eating out might have meant mushroom stroganoff with steamed
vegetables;foranother,itmighthavebeenvegetablesushiwithmisosoupand
salad.Aslongastheyavoidedanimalproductsandkeptoilstoaminimum,they
werefreetoshapetheirmealstotheirliking.
Forcomparison,weincludedacontrolgroupwhosemembersfollowedwhat
youmightthinkofasatypicalcholesterol-loweringdiet.Itcutbackonredmeat
whileemphasizingpoultryandfishalongwithplentyofvegetables,fruits,and
wholegrains.
The results were quick and impressive. The vegetarian group participants
lost about a pound per week; after 14 weeks, they had lost an average of 13
pounds,comparedto8poundsforthecontrolgroup.
7
bynow,it wasnosurprise thatthisdiet causesweightloss, butwewent a
step further. We sent our participants to the laboratory for a glucose tolerance
test,whichallowedustomeasurehowtheirbodiesrespondedtosugarandhow
well their bodies’ insulin was working. Each participant swallowed a dose of
sugary syrup, and we took blood samples every half hour to measure rises in
bloodsugarandinsulin.From theselaboratorydata, wewere ableto calculate
each woman’s insulin sensitivity and track how it changed as the study
progressed.
The results were remarkable. The tests showed that our participants were
physicallychanging.Basedontheirlaboratorymeasurements, itwas clearthat
theirbodies’cellswerebecomingmoreandmoresensitivetoinsulin.Bythe14-
weekpoint,theirinsulinsensitivityhadimprovedby24percent.Inotherwords,
something about the diet reactivated their natural insulin’s ability to open cell
doorstoglucose.Whatthatmeans,ofcourse,isthatthedietwasaddressingthe
fundamental problem we see in type 2 diabetes: It was helping glucose get to
whereitbelonged.
*
Based on these and other studies, the National Institutes of Health—the
researchbranchoftheUSgovernment—decidedtofundanewstudy.
8
Working
with me on the project were researchers from George Washington University
SchoolofMedicineandtheUniversityofTorontoanddietitiansandphysicians
working with the Physicians committeefor Responsible Medicine, a nonprofit
organizationIfoundedin1985.
Thestudyincluded99peoplewithtype2diabetes.For22weeks,49ofthem
followed a diet that was similar to those we had tested earlier. The diet was
vegan—meaningthatitincludednoanimalproductsatall—andwaslowinfat.
Also,whileweplacednolimitsontheamountofcarbohydratesourparticipants
could have, we encouraged everyone to be selective about the kinds of
carbohydratesthey ate.Instead ofwhite bread,we encouragedthemto choose
ryeorpumpernickel.Insteadofbakingpotatoes,wefavoredsweetpotatoesand
yams. The remaining 50 participants followed a diet based on the ADA
guidelines.Onceagain,werestrictedexercise.
Whatwashappeningwasthatthediethadmadetheircellsmoresensitiveto
insulin’saction,sotheywereabletotakeinnutrientsmorequickly.Glucosegot
outofthebloodandintothecells,wheremoreofitcouldbeburnedup,soto
speak.Thesecaloriesarereleasedasbodyheatratherthanbeingstoredasbody
fat.Scientistscallthisthethermiceffectoffood,anditprovidesa smallextra
edgeforweightloss.
Overtheensuingweeks,manyparticipantsfoundtheirbloodsugarfallingto
the extent thatthey had to cut back on theirdiabetes medications. That was a
happy outcome, but it was not our goal. In fact, we were trying to keep
medicationsunchangedasmuchaswecouldsowecouldisolatetheeffectofthe
diet on their blood sugar. The combination of the diet and the blood sugar–
loweringdrugswassopowerful,however,thatmanyparticipantshadtoreduce
theirdosesordiscontinuemedicationsaltogethertokeeptheirbloodsugarfrom
droppingtoolow.
To really gauge what the diet could do, we looked at those participants
whose medications had stayed constant and how the diet affected A1C—the
principalgaugeofbloodglucosecontrol.TheADAdiethadreducedA1Cby0.4
percentage point—a good change. But the vegan diet was three times more
effective. It had reduced A1C by 1.2 percentage points (the average person’s
valuefellfrom8.0to6.8percentduringthe22-weekstudy).Thatisastronger
effectthanisseenwithatypicaldiabetesmedication.Thevegandietalsoproved
highlyeffectiveinreducingbodyweightandcholesterol.
Toputallthisinperspective,thelandmarkUKProspectiveDiabetesStudy
showedthat a1-point dropin A1Cfor peoplewith type2 diabeteslowers the
riskofeyeorkidneycomplicationsbyabout37percent.
10
Thisistheeffectof
just the A1C drop without considering the ability of the diet to also reduce
cholesterolandbloodpressure.
11
Inthenextchapter,Iwillshowyouhowyoucantestthisdiettoseewhatit
candoforyou.Butlet’slookabitcloseratthesciencebehindthisapproach.
TOWARDTHEPERFECTDIET
Settingasideanimalproductsandkeepingoilyfoodstoaminimummaysound
challenging,butourparticipantscommonlyreportedjusttheopposite.Oneman,
Walter, said, “I’m amazed at how easy it was to adapt to this diet. And I feel
great.Within2months,Ilost20pounds.Andthemoreamazingthingtomeis
thatmyglucoseaverageshavefallenby30to40points.”
For Mark, the change was “an adventure. I tried new restaurants, new
recipes,anddifferentfoodsIwouldneverhaveeatenbefore.Mymaingoalwas
toloseweight,andI’velostagood30poundssofar.WhenIstarted,myfasting
bloodsugarwas260to360.Anditdroppedlikearock.NowI’mbetween130
and135.AndIdon’tgettiredintheafternoonlikeIusedto.”
Nancy agreed. She felt totally adjusted to the diet within about 30 days.
“Andwithin5monthsofmakingthechange,”shesaid,“mybloodsugarfellso
muchthatIwasabletostoponeofmymedications.Ihavemuchmoreenergy
andreallyfeeltremendous.”
Iwillwalkyouthroughthedietstepbystep.Ifitsoundslikeaveryhealthful
diet,itcertainlyis—andnotjustforcontrollingbloodsugar.
In1990,DeanOrnish,MD,ayoungHarvard-trainedphysician,discovereda
remarkablefeatureofalow-fat,vegetariandiet.Hetestedthedietinindividuals
withheartdiseaseand addedother healthylifestylechanges—regularexercise,
stress modification, and smoking cessation. Because the diet contained no
animal products, it had no cholesterol at all and very little fat. After a years
time,eachpatienthadaspecialx-rayoftheheartcalledanangiogram,andDr.
Ornish’steamcomparedtheresultswithangiogramsdoneonthesamepatients
at the beginning of the study. The results made medical history. The patients’
coronaryarteries,whichhadbeenblockedbyyearsofpoordiet,wereactually
starting to open again. The difference was clearly visible in 82 percent of the
patients after 1 year. This occurred without surgery or drugs—even without
cholesterol-loweringmedication.
12,13
Other researchers have shown that this same sort of diet change reduces
blood pressure. Apparently, eliminating animal fats reduces the viscosity
(“thickness”)oftheblood.Thatis,thebloodbecomeslesslikegreaseandmore
likewater,soiteasilyflowsthroughthearteries,causingbloodpressuretofall.
Blood pressure is also reduced by the potassium in vegetables and fruits, and
othercharacteristicsofplantfoodsaugmentthisbenefit.
14
Vegetariansareslimmer,too.Theaveragepersonwhoembracesavegetarian
dietlosesabout10percentofhisorherbodyweight.
Thesechangeswouldbewelcomedbymostofus,butifyouhavediabetes,
they can be lifesaving. This is because, as you saw in Chapter 1, persistently
highbloodsugarcanattackthebloodvesselsofyourheart,eyes,kidneys,and
legs. What kills most people who have diabetes (that is, those who have not
madethedietchangesyouarereadingabout)isdamagetotheirhearts.Adiet
that reverses that process—turning the clock backward on heart disease,
reducing blood pressure, and trimming weight—is powerful medicine for
everyonewithdiabetes,whethertype1ortype2.
Imagine if your eyes were damaged by the disease. An ophthalmologic
surgeon,laserinhand,wouldcarefullytrytorepairyourtenderretinas.Butwhat
iffoodscouldhelpavertthisdamageinthefirstplace?Adietchangethatbrings
your blood sugar under control, brings your blood pressure down, and helps
rejuvenateyour arteriesgivesa measureof respitetothe tinybloodvesselsin
youreyes.Itdoesthesameforthetinyvesselsthatmakeupthefilteringunitin
your kidneys, making it less likely that you will ever need dialysis. And of
course,itworkspowerfullyinsidetheheart.
Now, donot misunderstandme. Iamnotsuggestingthat youshould forgo
neededmedicaltreatmentsandrelyondietalone.Butadietchange—ifitgoes
farenoughandbeginsearlyenough—canrevolutionizeyourhealth,dramatically
cutyourriskofcomplications,andevenreversethesecomplicationstoadegree.
INSIDETHECELL
In discussing type 2 diabetes, I have described each cell of the body as being
rather like a gummed-up lock. Research has shown this analogy to be
surprisinglyapt.Indeed,insulin’sabilitytoworkisblockedbytheaccumulation
ofsomethingwithinthecells:notgum,butfat.
In the February 12, 2004, issue of the New England Journal of Medicine,
YaleUniversityresearchersreportedanamazingdiscovery.
15
Theytestedyoung
adultswhoseparentsorgrandparentshadhadtype2diabetes.Allwerethinand
healthy, and none had diabetes at that point. But some were insulin resistant,
meaningthatwhentheyweregivenatestdoseofglucose,itbuiltupmorethan
itshouldhaveintheirbloodstream.Theresearchersfoundoutwhy:Insidetheir
musclecellsweretinyamountsoffat,fatthatinterferedwithinsulin’sabilityto
work.Theirbodiesmadeinsulinnormally,anditreachedtheirmusclecellswith
noproblem.Onceitgotthere,though,itdidnotworkproperly.Themusclecells
simplycouldnotfullyrespondtoinsulinbecausetheycontainedbitsoffat,like
gumjammedinalockrenderingakeyuseless.
Howdidthisfatgetthere?Well,musclecellsnormallystoreatinyamount
of fat, which provides an energy source for physical activity. The amount is
normallyquitesmall,andthefatsimplywaitsforthatdaywhenyouaremuch
moreactivethanusualandneedabitofextraenergy.Forsomereason,inthese
young people, fat had built up much more than it should have—to levels 80
percenthigherthaninotheryoungpeople.Thefatbuilduphadreachedthepoint
where it was gumming up the lock. That is, it was interfering with the cell’s
abilitytorespondtoinsulin,andthatmeantthatdiabeteswasverylikelyintheir
futureunlesssomethingchangedinamajorway.
I should emphasize that the fat inside your cells is different from the fat
aroundyourwaistline.Evenifyouarequiteslim,youmaystillbeaccumulating
fat within your muscle cells. The participants in the Yale study were slim,
averaging only 141 pounds. They were young and healthy. But just as young
peoplewhosmokearesetting thestageforcancerdecadeslater,young people
whoaccumulatefatinsidetheirmusclecellsarepavingthewayfordiabetes.
Untilnow,diabetesdietshavenotbeendesignedtoalterwhatgoesoninside
thecells.Instead,theyhavebeendesignedtocompensatefortheproblem,soto
speak. Because your cells cannot handle glucose—that is, insulin has trouble
getting glucose into them—the diets limit sugars and foods that contain
carbohydrate, because when carbohydrate is digested, it releases sugars. But
whatifachangeindietcouldactuallyalterthefatbuildupwithinthecellsand
reversethetrendtowardgraduallyworseninginsulinresistance?
Ibelieve thisis exactlywhat wecan do—exactlywhatyou willdo as you
makethedietchangesdescribedinthisbook.Butfirst,afewmoredetailsfrom
insidethecells.
Normally, insulin attaches to receptors on the cell’s surface and signals the cell membrane to
allowglucosetoenter.However,iffat,calledintramyocellularlipid,accumulatesinsidethecell,it
interferes with insulin’s intracellular signaling process. Tiny organelles, called mitochondria, are
supposedtoburnfat,andtheirfailuretokeepupwiththeaccumulatingfatmaybetheoriginof
type2 diabetes. Luckily, evidence showsthatdietchangescanreducethe amount offatinside
thecell.
TINYFURNACESTHATBURNFAT
Thereisatermforthetinybitsoffatthatbuildupinsidemusclecells.Scientists
call them intramyocellularlipids (intra- means “inside,” myo-is “muscle,” and
lipidis“fat”—literally,fatinsidemusclecells).Asyouhaveseen,thesetracesof
fatstartaccumulatingmanyyearsbeforediabetesmanifests.
16
Let’sgoonestepfurtherandlookathowthefatbuildsup.Yourcellshave
microscopic“furnaces”or“burners”thataresupposedtometabolizebitsoffat
and convert it into energy. If all is operating normally, fat enters the cell and
thesetinyburnersuseitup.Theseburnersarecalledmitochondria,andtheyare
responsible for turning fat or other fuel sources into energy to power your
musclecells.Ifyouaresteadilyaccumulatingfat,thatisasignthatyourburners
—yourmitochondria—arefallingdownonthejob.
Intype2diabetes,theproblemappearstobetoofewmitochondria.Thatis,
peoplewithtype2diabeteshavefewermitochondriathantheyneedtoburnup
theaccumulatingfat.Iftheyhadmoreoftheselittle“furnaces”insideeachcell,
thingswouldbeverydifferent.
Surprisingly enough, it may be that the number of mitochondria you have
dependsonwhatyoueat.Letmedescribeasecondresearchstudy.
At Pennington Biomedical Research Center in Baton Rouge, Louisiana,
researchers studied 10 young men. They averaged just 23 years of age; were
reasonably trim, averaging 174 pounds; and were healthy. The researchers put
themonahigh-fatdietthatdrewabouthalfitscaloriesfromfats.
17
Thisismuch
morefatthanyouwouldwanttohaveinyourdiet,butitisnotfardifferentfrom
whatmanypeopleactuallyeat.Afterjust3daysonahigh-fatdiet,themenhad
accumulatedsignificantlymoreintramyocellularlipids,sothefirstlessonofthis
studywasthatfatbuildsup quickly.Dependingon thefoodsyou eat,you can
packfatintoyourcellssurprisinglyrapidly.
Thentheresearcherstestedthegenesthatproducemitochondria.Justasyou
havegenesinyourcellsthatallowyoutomakebones,hormones,skin,hair,and
alltheotherstructuresofyourbody,youalsohavegenesthatserveasblueprints
formitochondria.Itturnedoutthatthefattyfoodsthesevolunteersatedidmore
thanjustpackfatintotheircells;theyactuallyturnedoffthegenesthatwould
help burn fat. The genes that produce mitochondria were in fact partially
disabled.Itwasasifthemen’sbodiesweretryingtoavoidburningthefatthey
hadeatensotheycouldsaveitinsidethecellsforfutureuse.
Imaginewhatthis means:You have eatenfatty foods and,as a result,tiny
bits of fat have accumulated in your muscle cells. This fat interferes with the
normal workings of the cells, including their ability to respond to insulin. If
insulinisunabletowork,glucosecannotgetintothecells,anditbuildsupinthe
bloodstream. Then, those fatty foods actually seem to disable your genes that
wouldproducethemitochondriayouneedtoburnupthisaccumulatingfat.Your
abilitytoeliminatefatinsideyourcellsseemstobesloweddownwhenyoueat
fattyfoods.
Letmespeculateaboutwhyallthisoccurs.
Yourbodychemistrybegantotakeshapemanythousandsofyearsago,long
beforefast-foodrestaurantsandconveniencestoresevergottheirfirstshipments
ofcheeseandfryergrease.Ourhumanancestorsdidnotfindfattyfoodsgrowing
ontrees—oratleastnotmanyofthem.Ontherareoccasionswhentheyatefatty
foods—meat, eggs, nuts, or avocados, for example—theirbodiesmay actually
have tried to save some of the fat from these foods in case they needed it to
powertheirmusclesorfoodbecamescarce.Thus,itwouldnotbesurprisingifa
suddeninfluxoffatinthemusclecellssignalsthemtoturnoffthefat-burning
mitochondriaandsavethefatforfutureneeds.Today,ofcourse,thatisthelast
thing we want. We want to power up our mitochondria—turn on those little
furnacestoeliminatefat.
Well, canyou get rid ofthis fat? Let’s sayyou stopped eating fattyfoods.
Wouldintramyocellularlipidstarttodisappear?
Letmesharetheresultsofastartlingexperiment.AtCatholicUniversityin
Rome,Italy,eightpatientsunderwentgastricbypasssurgery.
18
Theoperationis
commonly done as a last-ditch treatment for massive obesity, and for good
reason.Whatitinvolvesisthis:Thestomachisstapledsothatonlyatinypouch
aboutthesizeofaneggislefttoreceivefood.Thentheintestineiscutintwo.
Thefirstpartoftheintestinesimplyliesunused,whilethelowerportionofthe
small intestine is attached directly to the tiny stomach pouch. In this way, the
patientcannoteatmuchfood,andthereismuchlessintestineavailabletoabsorb
thenutrientsfromwhateverfoodiseaten.
After the procedure, the patients were essentially starving. They could eat
verylittle foodat anygiven meal,and anyfats theyate werepoorly absorbed
because the first part of the small intestine, which is where fats are absorbed,
wasnolongerconnectedtothestomach.
Asyoumightimagine,theylostweight,droppingfromanaverageofmore
than300pounds(137kg)to229pounds(104kg)inthefirst6months.Thatis
notunusualaftersuchdrasticsurgery.Whatwasstrikingwastheeffectontheir
cells.Thefatinsidetheirmusclecells—theirintramyocellularlipid—droppedby
87percent.Andeventhoughtheywerestilloverweight,theirinsulinresistance
hadlargelydisappeared.
Iamnotrecommendingthatyouhavethisprocedure.Iampresentingthese
findingstomake acriticallyimportantpoint:The fatinsideyourcellsis nota
permanentfixture.Iftheinfluxoffatstops,thefatinsidethecellsdissipates,and
whenthathappens,thecellsstarttoregaintheirnormalfunction.
Surgeryisadrasticsolution,buttheItalianresearchersalsotestedwhethera
low-caloriedietwithoutsurgerycoulddepleteintramyocellularlipid—anditdid.
Followinga1,200-caloriedietfor6months,thepatientslostabout30poundson
average and eliminated about 8 percent of the fat inside their cells. Now, that
modestresultcamefromadietthatfocusedjustoncuttingcaloriesratherthan
oneatingparticulartypesoffood,whichwillbethefocusofthisprogram.The
nextstepistomakethedietmorepowerfulsoitworksalittlemorelikesurgery,
withoutalltheobviousrisksofanoperation.
Let’sgoastepfurther.AtImperialCollegeSchoolofMedicineinLondon,
researchers studied a group of individuals following a vegan diet. They
comparedtheparticipantstootherswhoweresimilarinageandbodyweightbut
were not following a vegan diet.
19
When the researchers measured the
intramyocellular lipid in each participant’s calf muscles, they found it was 31
percent lower in the vegans than in the omnivores. It looks as if there is
somethingaboutthedietthathelpspreventfatbuildupincells.
Thesestudiesshow—loudlyandclearly—thattheaccumulationoffatinthe
cellsandalltheproblemsitcausesarenotsimplyamatterofgenes.Genesdo
play a role, but these effects are very much a matter of diet, too, and it can
changedramatically.
InPart2, you will see how to select foods to address this problem in the
mostpowerfulwaypossible.
*
Thestudyturnedupanotherparticularlyremarkablefinding.InalaboratoryatgeorgeWashington
University,wemeasuredtheparticipants’metabolism—howfasttheirbodiesburnedcalories.Thiswas
donebymeasuringhowmuchoxygentheyconsumedminutebyminuteandhowmuchcarbondioxidethey
producedafterbeinggivenatestmeal(twocansofastandardliquidformula).
After14weeksontheexperimentaldiet,itwasclearthattheparticipantshadasignificantincreasein
theirafter-mealcalorieburn;theirafter-mealcalorie-burningspeedincreasedby16percent.
9
CHAPTER3
ARevolutioninType1Diabetes
Ifyouhavetype1diabetes,thedietchangesyouwillsoonlearnaboutcanbe
lifesaving. No doubt you have heard that type 1 diabetes increases the risk of
heartproblemsandothercomplications.Whenyoureallytakecontrol,however,
alltheserisksplummet.
Researchhasproventhatyouarenotpowerlessagainstthecomplicationsof
diabetes.Thereisalotyoucandotoprotectyourself.
The Diabetes Control and Complications Trial did it with medication. The
studywassponsoredbytheUSgovernmentandincluded1,441peoplewithtype
1 diabetes. Some of the participants took insulin once or twice daily, as is
common practice. The remaining participants were asked to follow a more
intensiveprogram.Theytookinsulinthreeorfourtimesdaily,eitherbyinjection
or viaaninsulin pump. They checkedtheir blood glucose several timesa day
and adjusted their insulin doses accordingly. Over 17 years of follow-up, the
extracaretheseindividualstookpaidoffdramatically.Carefultrackingofblood
sugar and medication adjustments lowered the risk of heart problems by 50
percent.
1
Also, although people with diabetes are at risk for eye problems, careful
blood glucose control reduced that risk by 76 percent compared to people on
traditionalmedicaltherapy.Itcuttheriskofkidneyproblemsby39percentand
reducedtheriskofneuropathyby60percent.
2
The study treatment involved medication rather than diet, but it proved a
vitallyimportantpoint.Manypeople hadimaginedthatdiabetescomplications
are simply inevitable; this study showed otherwise. Gaining control over your
blood glucose makes an enormous difference. Now, with type 1 diabetes, you
will need to use insulin to achieve that goal. But diet and exercise offer
additionalpowerthattoofewpeopletakeadvantageof.Anddietisthefocusof
thisbook.
Also,itisimportanttounderstandthatbloodsugarcontrol—asvitalasitis
—isjustonepartoftheequation.Yourriskofdevelopingproblemswithyour
heart, kidneys, eyes, or extremities also depends on your blood pressure,
cholesterol levels, and other factors. The goal now is to adjust your diet to
controlall ofthese tothe extentthatwe can,adding medicationsas necessary
accordingtoyourdoctorsadvice.
TOWARDANOPTIMALLIFESTYLE
Intype1diabetes,yourgreatestriskistoyourheartandbloodvessels.Ifyoudo
nothing, cardiovascular disease lies in wait. In fact, it strikes the majority of
people with type 1 diabetes. We now have a better understanding than ever
beforeabouthowtousedietandlifestylechangestoprotecttheheart,notonly
forpeople withdiabetes butfor anyone.Chapters4and5 will cover how and
whattoeatingreatdetail,andChapters12and13willdiscussthecomplications
head-on.Inthemeantime,herearethekeys.
A healthy diet. Follow the diet steps outlined in the next chapter. These
practiceseliminatecholesterolandanimalfat,keepfatsingeneralverylow,and
guide you away from sugar and refined carbohydrates and toward healthy
complexcarbohydrates.
Asyouwillsee,thereisaspecialadvantagetoavegetariandiet,orIshould
say a vegan diet—meaning a menu that includes no animal products at all.
Dietarycholesterolisfoundonlyinanimalproducts.
*
Animalproductsalsotendtobehighinthesaturated(“bad”)fatsthattendto
causeyourbodytomakeadditionalcholesterol,aneffectthatisactuallymuch
greater than eating cholesterol itself. A plant-based diet eliminates these
problems.Ithasanothermajorbenefitaswell:Itderivesitsproteinfromplants
rather than from animal products. Research studies have shown that among
peoplewithanydegreeof kidneydamage, animalproteinincreases theriskof
further kidney deterioration.
3
On the other hand, healthy beans, grains, and
vegetablesarejustwhatyourkidneysordered.
Aplant-baseddietdoesmorethanreduceyourriskofcomplications.Itmay
alsoreducetheamountofinsulinyouneed.Whenpeoplewithtype1diabetes
begin a low-fat, vegan diet, many report that their insulin requirements fall
dramatically. Although the reasons for this are not entirely clear, it is a very
welcomeresult.
Please read the next chapters very carefully. They will show you how to
begin.
Nosmoking. If you smoke, now is the time to stop. If you have tried 50
times,itistimefortrynumber51.Youcanandwillsucceed.Askyourdoctorto
helpyou.
Regularexercise.Evenmodestexercise,suchasdailywalking,makesabig
difference. See your doctor, who will assess your heart, your joints, and your
overallhealthtomakesureyouarereadyforexercise.SeeChapter11forways
togetstarted.
Stress management. Stress affects your health directly, causing fight-or-
flight hormones to flood into your bloodstream. In turn, these hormones
typically raise your blood sugar. Stress also disrupts your eating routines and
interfereswithsleep.
Gettingahandleonstressdoesnotmeansteppingbackfromthechallenges
oflife.Itmeansfindingwaystoenjoylifefullywithoutlettingstressgetoutof
control.Therearemanyhealthywaystorelax,includingmeditation,yoga,and
evensimplebreathingexercises.
Asyousawinthepreviouschapter,Dr.DeanOrnishshowedthatthesefour
steps—ahealthyvegetariandiet,smokingcessation,regularexercise,andstress
management—can actually reverse heart disease, even without the use of
cholesterol-loweringmedications.Thatisatremendousbenefit.Yourdoctormay
addmedicationstoyourregimentoprotectyoufurther.
Theselifestylechangeswillnoteliminatetheneedtouseinsulinfortype1
diabetes.Buttheycanhelpyoustayhealthy,minimizingtheeffectsofdiabetes
onyourlife.
ANEWUNDERSTANDINGOFTHECAUSESOFTYPE1DIABETES
Let’s think for a moment beyond improving the health of people with type 1
diabetes.Whatifwecouldactuallypreventitinthefirstplace?Researchover
thepast3decadessuggeststhatwemayalreadyhavetheabilitytopreventmany
casesoftype1diabetes.
Ifyouthoughtthediseasewassimplygeneticandtherewasnowaytostop
it,readon.Studiesofidenticaltwinshavesetthatnotionaside.Identicaltwins,
of course, have exactlythe same genes, so they have thesame hair color, eye
color, and facial features. If a disease were simply genetic, then both twins
wouldhave it.Buttype 1diabetesdoes notworkthat way. AsImentioned in
Chapter1,ifonetwinhasdiabetes,theotherhaslessthana40percentchanceof
developingit.
So,althoughgenesplayarole,itisclearthattype1diabetesisnotsimplya
genetic disease. Something else triggers it—something in the child’s early
environment.
For many years, researchers have known thattype 1 diabetes occurs when
the immune system attacks and destroys the insulin-producing cells in the
pancreas. Your immune system, of course, is your defense against viruses,
bacteria, and cancer cells. It is not supposed to attack your own healthy body
tissues,butthatisexactlywhatoccursintype1diabetes.
To understand why this happens, let’s look at a few basics. The complex
defensenetworkofyourimmunesystemismadeupofspecializedwhiteblood
cells.Someofthesecellsengulfinvadinggermsanddigestthem.Othersmake
antibodies—molecules that attach to invading organisms like harpoons and
identifythemforotherimmunecellstoattack.Ifyouhavetype1diabetes,your
immune system has made a major error: It has attacked and destroyed your
insulin-producingcells,resultinginwhatscientistscallanautoimmunedisease.
But why does it occur? Back in 1992, a team of Canadian and Finnish
researchers reported an important discovery in the New England Journal of
Medicine. Examining blood samples from 142 children newly diagnosed with
type 1 diabetes, they found that each of the children had antibodies that were
primedtoattackcow’smilkproteins.Theseantibodieshadapparentlyarisenin
response to cow proteins in their infant formula, but the antibodies were also
capable of attacking the body’s insulin-producing cells.
4
It turned out that a
portionofthecow’smilkproteinwasbiochemicallyanexactmatchforaportion
ofhumaninsulin-producingcells.Theantibodiesthatarosetodestroythecow’s
milk protein ended up attacking the children’s insulin-producing cells. The
pancreaticcellsweredestroyedby“friendlyfire.”
Thisstudyandotherssuggestedascenariothatcouldleadtotype1diabetes.
Ithaslongbeenknownthatwhenaveryyounginfantisfedcow’smilkformula,
someofthemilkproteinspassfromthedigestivetractintothebloodstream.
5,6
It
ispossiblethattheinfant’simmunesystemrecognizesthesebovineproteinsas
foreignandformsantibodiestoattackthemandthattheseantibodiesattacknot
onlythecowproteinsbutalsotheinsulin-producingcellsofthepancreas.This
destructiveprocessispresumablygradual;whennearlyalltheinsulin-producing
cellsaregone,type1diabetesresults.Theresearchersbelievedthatthemature
digestivetractsofadultswouldnotallowthesedairyproteinstopassthroughthe
intestinal wall and into the bloodstream, but in infants, the molecules passed
throughmoreeasily.
The study suggested that one way to prevent type 1 diabetes, at least for
manychildren,mightbetoavoidexposuretocow’smilkearlyinlife.Needless
tosay,inthe early1990s,neitherparents norpediatricianshadany ideaabout
this.Cow’smilkformulaswereroutinelyfedtoinfants,andtheystillare.When
childrenarenotbreastfed,somesortofformulahastobeused.Andwhilesome
children are given soy formulas that would presumably pose no diabetes risk,
manyaregivencow’smilkvarieties.
In 1992, when the New England Journal of Medicine report emerged, the
well-known babydoctor Benjamin Spock, MD,andI held a pressconference.
We were joined by Frank Oski, MD, director of pediatrics at Johns Hopkins
University,andothernutritionexperts.Werecommendedthatparentsbegiven
informationaboutthepotentialrisksofearlyexposuretocow’smilk.Afterall,
parentsarepushedveryhardtogivecow’smilktotheirchildren,buttheyrarely
hearofpotentialrisksitmightpose.Wecalledforanendtorecommendations
thatpushmilkconsumptiononchildrenandsaidthatparentsshouldhavegood
informationinordertodecidewhattofeedtheirchildren.
The event proved controversial. Most major newspapers and broadcast
channelscoveredthestory.TheAmericanMedicalAssociation(AMA)sharply
criticized Dr. Spock and me for casting doubt on the healthfulness of dairy
products. Research teams trying to replicate these findings got mixed results,
with some coming up empty-handed. Still other researchers pointed out that
findingtheantibodiesrequiredspecialtechniques,withoutwhichtheantibodies
would remain elusive.
7
Eventually, the American Academy of Pediatrics
convened a work group to look into the matter. Two years later, in 1994, the
group issued a report. Based on more than 90 studies, the group agreed that
indeed,theriskofdiabetescanverylikelybereducedifinfantsarenotexposed
to cow’s milk proteins early in life.
8
Eventually, the AMA withdrew its
objections.
WhileDr.SpockandIfelttherewasalreadysubstantialevidenceandgood
reason to issue cautions about exposure to dairy products early in life, the
controversydidnotendthere.Therewasonlyonewaytoknowwhetherdairy
proteinscouldactuallyincitetheseriesofeventsleadingtotype1diabetes:The
theoryhadtobeputtothetest.Aeuropeanteambeganthatprocess.
TESTINGTHEDAIRY-DIABETESTHEORY
In a pilot study, researchers in Finland, Sweden, and Estonia identified 242
newbornsatriskfordevelopingtype1diabetes—eachhadafirst-degreerelative
withthecondition.Theresearchersthenencouragedtheirmotherstobreastfeed.
Whenmotherswerereadytoweantheirinfants,theresearchersaskedhalftouse
aspeciallymodifiedbabyformulainwhichdairyproteinswerebrokenupinto
individual amino acids—protein building blocks that are too small to elicit an
immunereaction.Theotherfamilieswere allowedtouse aregular cow’s milk
formula.The research aimedto see whetheravoiding exposureto intact cow’s
milkproteinscouldreducethelikelihoodofdevelopingdiabetes.
9
Astheyearswentby,theresearchersfoundthatthechildrenwhowerefed
thespecialformulaweremuchlesslikelytodevelopthedangerousantibodies.
Infact,theriskofdevelopingantibodiestotheirinsulin-producingcellswascut
by62percent.
Thestudywassmall,onlyapilottrial,butitdidfollowmostofthechildren
through their first 6 to 8 years of life. During those years, several children
developeddiabetes.Ofthosereceivingunmodifiedformula,eightdevelopedthe
disease,andinthemodified-formulagroup,fivedevelopedit.Asitturnedout,
two of those five had dropped out of the study right at the start and never
actually receivedthe modified formula. Thatmeant that only threechildren in
the modified-formula group developed diabetes, compared to eight in the
regular-formulagroup.Thestudysuggestedthatthecow’smilktheorymaywell
bepartofthepuzzle,butitwastoosmalltobedefinitive,andtheresearchteam
beganamuchlargertestin2002involvingfamiliesin15countries.
There were some limitations to this pilot study. First, it restricted dairy
consumptiononlyduringthefirstseveralmonthsoflife.Itisnotclearwhether
laterexposure,say,at8or9monthsofage,mightputsomechildrenatriskas
well.After all,ithas longbeen knownthatvery large dairyprotein molecules
cansometimespassfromthedigestivetractintothebloodstream,eveninadults.
Thestudydidnotaddresswhetherexposuretodairyproteinscouldtriggertype
1diabetesinchildrenwhoarebeyondearlyinfancy.
Second,thestudydidnotaskbreastfeedingmotherstoavoidcow’smilkin
their own diets. For decades, we have known that some cow’s milk proteins
ingested by a nursing mother end up in her breast milk. They come from her
digestive tract, are absorbed into her bloodstream, and find their way into the
breast milk, sometimes making babies colicky.
10
Thus, in order to avoid
exposingbabiestodairyproteins,itisimportanttoeliminatethemnotonlyfrom
infants’dietsbutalsofromthedietsoftheirbreastfeedingmothers.
Onelastcautionaboutthisstudy:Itdidnotactuallyexcludedairyproducts
fromthechildren’sdiets.Rather,itusedamilkproducttreatedtobreakupthe
dairy proteins. If anything in milk other than these proteins contributes to the
problem, this study would not have been able to detect it. Even so, it was an
importantstepincomingtounderstandhowpartsofaninfant’sdietmayleadto
diabetes.
Thestudyilluminatedothercontributorstodiabetes,too.Priorevidencehad
suggested that viral infections may play a role, and indeed, viruses appear to
have done so for some infants in the milk study. Specifically, viruses seem to
stimulate immune cells, perhaps making them more active against cow’s milk
proteinsthantheywouldnormallybe.Or,cow’smilkproteinsmayinfluencethe
courseofviralinfectionsinsomeway.
11
Theideaisthattheinterplaybetween
cow’smilkformulaandvirusesmayputbabiesatincreasedrisk.
Nooneknowswhattheresearchonmilkandtype1diabeteswillultimately
show.Ifthetheoryturnsouttobecorrect,itsuggeststhatavoidingcow’smilk
products,atleastduringthefirstseveralmonthsoflife,couldgreatlyreducethe
likelihoodofdevelopingthisdisease.
Needlesstosay,breastfeedinginsteadoffeedingformulaposesnorisksfor
children.Quitetheopposite:Breastfedbabiesgainmanyadvantages,including
betteroverallhealthandevenafewextraIQpoints,comparedtotheirformula-
fed counterparts. And the most healthful breastfeeding is done when mothers
followadietfreeoffoodsthatcanharmtheirbabies.
Otherriskfactorsfordiabetesmayyetemergeinresearchstudies.Andfor
children who are already in the midst of an antibody attack, researchers are
studying means of intervening to try to stop the destruction of their insulin-
producingcells.
STAYINGHEALTHY
If we are able to prevent diabetes, we will have a very powerful tool at our
disposal.Forpeoplewhoalreadyhavetype1diabetes,thereareeffectivesteps
theycantaketohelpthemstayhealthy.Keepingbloodglucoseundercontrolis
essential,andstabilizingcholesterollevelsandbloodpressureprotectstheheart
andbloodvessels.Thesamesortofdietthatisdescribedinthisbookfortype2
diabetes is likely to be enormously beneficial for people with type 1 as well,
helpingthemtopreventcomplicationsandreducetheirinsulindoses.
*
Itisagoodideatoeliminatecholesterolfromyourdietcompletely.Thereisno“good”cholesterolin
foods.Rather,cholesterolinfoodsalwaystendstoincreaseyourbloodcholesterollevel.Thisisincontrast
tocholesterolthatismeasuredbybloodtests,whichdoctorsseparateinto“good”(HDL)cholesteroland
“bad”(LDL)cholesterol,amongotherforms.HDLcholesterolis“good”becauseitisleavingthebody.
PART2
TheProgram
CHAPTER4
APowerfulNewMenu
Wearesettingoursightsonadramaticallybetterresultthanpreviousdietscould
deliver—a result that’s possible through a new approach to eating that I will
explaininthischapter.Ifyouhavetype2diabetes,youdonotwanttocaterto
insulin resistance; you want to counteract it. If you have type 1 diabetes, you
want to get your blood sugar under good control, minimize your medications,
and stay in good health. This chapter will show you the principles of
revolutionizingyourmenu.Then,inthefollowingchapters,Iwillshowyouhow
toputthemtoworkasyouplanyourmeals.
Fortype2diabetes,ourgoalisto“cleanthegumoutofthelocks.”Asyou
recall, the fundamental problem in type 2 diabetes appears to be the
accumulationoftinyamountsoffatinsidemusclecells.Theymakeithardfor
insulinto do itsjob by blockingwhat iscalled insulin signaling.That is,they
interfere with the process by which insulin opens the cell membrane to allow
glucosetoenter.Youneedtoselectfoodsthatreversethisprocess.
Adietrevampcanalsohelpprotectyourbodyfromthediseaseprocess.That
iscrucialforbothtype1andtype2diabetes.
Asyouwillsee,thesedietchangesarefar-reachingandpowerful.Youmay
also find, as many of our study participants did, that learning the plan’s
guidelines is a simple process. There are no limits on portions, calories, or
carbohydrates.Youwillfocusonwhatyoueat,sohowmuchyoueatgenerally
takescareofitself.Butwearegettingaheadofourselves.
Let’sfirstlookatthemenuchangesthatmakethedietsoeffective.Then,in
the following chapter, I will walk you through various ways to adopt them to
makethisdietdoableforyou.
Toreversethecourseofdiabetes,“cleanthegumoutofthelocks,”andallow
theheartandbloodvesselsthebestchanceofreversinganyexistingblockages,
therearethreeguidelines.
1. Setasideanimalproducts.
2. Keepvegetableoilstoaminimum.
3. FavorfoodswithalowGlycemicIndex.
Now, there is no need to panic. I know this sounds like a tall order. I am
goingtowalkyouthrougheachsteptoshowyouthewhysandhows.Soon,it
willbesecondnature.Fornow,Ijustwantyoutounderstandtheprinciples.
1.SETASIDEANIMALPRODUCTS
Therearetwopossiblesourcesoffatinthediet:animalproductsandvegetable
oils.Thisguidelinetacklesthefirstofthese.
Needlesstosay,ifyouarenoteatingbeef,youwillnotgetanybeeffat.If
you are not eating chicken, you will not get any chicken fat. Following this
guideline means purging the animal fat from your diet. The program you are
abouttostartomitsmeat,dairyproducts,andeggs.
AsyousawinChapter2,researcherswhomeasuredthefatinsidethemuscle
cellsofpeopleonhigh-fatdietsshowedthatthefatyoueatcanrapidlyincrease
theamountoffatinyourcells.Exactlytheoppositeappearstohappeninpeople
whoavoidanimalproducts.Asyourecall,peoplefollowingavegandiethad31
percentlessintracellularfatcomparedwithpeopleonaregulardiet.
1
Thatmeans
improved insulin sensitivity. That is a great start, and the next guidelines are
designedtocarryyoufurther.
You will get another benefit. When you set aside animal products, you do
more than free yourself from animal fat; since animal products are the only
sourceofcholesterolinthediet,leavingthemoffyourplatealsoeliminatesall
thecholesterolfromyourdiet.Asyourcellsreclaimtheirhealth,therestofyour
bodydoes,too.
Insteadofeggsandbaconforbreakfast,youmighthaveabigbowlofold-
fashionedoatmealwithcinnamonorblueberries,halfacantaloupe,andsomerye
toast.Perhapsyoumightaddsomeveggiesausageorveggiebacon.
Forlunch,insteadof,say,meatchili,youmighthaveveggiechiliorhearty
lentilsoup.Ifyougenerallygoforaburger,youmightchooseaveggieburger.If
youhavedinneratan Italianrestaurant,you mighthave spaghettiwithtomato
sauce, wild mushrooms, artichoke hearts, and fresh basil. At a Mexican
restaurant, you would skip the meat taco in favor of a bean burrito (hold the
cheese)orveggiefajitas.AtaChineserestaurant,youcouldhaveyourpickof
themanyvegetabledishesonabedofrice.
Atthispoint,youmaybethinking,“Spaghetti?Rice?AmIallowedtohave
these carbohydrate-rich foods?” The answer is yes. Now, I know that people
withdiabeteshaveheardoverandoverthattheymustlimitrice,pasta,andother
starchyfoods.Butkeepinmindthatdiabetes—andoverweight—hasbeenrare
in countries that have made these foods their staples. The plan does have
guidelinesaboutcarbohydrates,buttheyrelatemainlytowhichonesarethebest
choices,nothowmuchyouputonyourplate.Inourstudies,wehavefoundthat
peoplewhoincludeplentyofhealthycarbohydratesintheirdietsdobetter,not
worse.
“Icanunderstandomittingbeef,”youmaysay,“butwhyeliminatechicken
andfish?”Well,thenutritionalmakeupofthesefoodsmaysurpriseyou.They
have significant amounts of fat and cholesterol, and they lack the fiber and
healthycarbohydrateyouneed.
Chicken,ofcourse,iswherechickenfatcomesfrom.Evenifyoustripaway
theskinandeatonlywhitemeat,about23percentofthecaloriescomefromfat.
Much of that fat is the “bad” form—saturated fat, the kind that pushes your
cholesterolupwardandworsensinsulinresistance.
Fish vary. Some types are lower in fat than chicken, while others, suchas
salmon,arequitehigh.Butallfishhavefat,andmuchofit—between15and30
percent—is saturated fat. Allfishhave cholesterol, too. Some, such as shrimp
andlobster,aremuchhigherincholesterol,ounceforounce,thansteak.
Ofcourse,somepeopleeatfishpreciselybecauseithasfatinit.Thatis,a
portion of the fat in fish is in the omega-3 form. Omega-3 fats are reputed to
blocktheformationofbloodclotsthatcouldleadtoheartattacks.
Scientific evidence has not been supportive. In large, carefully conducted
researchstudies,fishoilshavenotbeenshowntoprotecttheheart.Theydonot
reducethelikelihoodofaheartattackorstrokeorreducetheriskofdying.They
do not helphealthypeople who are trying to averttheirfirst heart attack, and
theydonotworkforpeoplewhohavealreadyhadaheartattackandaretrying
toavoidanotherone.
2,3
Could the supposed benefits of omega-3s be just a fish story? Well, it is
importanttorememberthatfishfatsaremixtures,justasallfatsare.Fishoilsdo
indeedcontainsomeomega-3fat,buttheyalsocontainplentyofsaturatedfat.
Asnotedabove,from15to30percentofthefatinfishisplainoldsaturatedfat.
That’slessthaninbeef(about50percent)orchicken(about30percent),butitis
considerablymorethanyouneed.Thereisnospecificneedforsaturatedfatin
yourdietatall.
The load of fat in fish might explain the disconcerting fact that fish
consumption is linked to a higher risk of developing diabetes. In 2009, the
American Diabetes Association reported in its journal, Diabetes Care, that
peoplewhoregularlyatefish,butnoothermeats,hada4.8percentprevalence
ofdiabetes,comparedto3.2percentforlactoovo-vegetariansand2.9percentfor
vegans.
4
In other words, having fish in your diet does not help; it actually
increasesdiabetesrisk.
Similarly,Harvardresearchersfoundthatpeoplewhoatethemostfishhada
24 percent higher risk of developing diabetes, compared with those who
generallyavoidedfish.
5
Finally,ifyouarelookingtoloseweight,itisimportanttonotethat“good
fats” packin just asmany calories as“bad fats.” Thatis to say, omega-3s are
everybitasfatteningasanyotherfatoroil.Allfatsandoilshave9caloriesin
everygram,comparedwithonly4caloriespergramofcarbohydrate.
In practice, chicken-and-fish diets are routinely disappointing. We have
carefully tested these diets and found that, even when they are followed very
closely,theirabilitytoreduceLDL(“bad”)cholesterolisonlyabouthalfthatof
a plant-based (vegan) diet, and their ability to control blood sugar or blood
pressureortohelpyouloseweightislimited,too.
6
Muchmoreeffectivearedietsthateliminateanimalproductsaltogether.Our
studiesandthoseofotherresearchershaveshownthatplant-baseddietscutLDL
cholesterolfarmoreeffectivelythananyotherdietapproach.
Now,youwillnoticethatwhenyouavoidanimalproducts,yourdietisnot
justfreeofanimalfat;itisalsofreeofanimalprotein.Thatisimportantbecause
animalproteincanharmthekidneys,andprotectingthemisakeygoal.Protein
fromplantsourcesisthewaytogo.
If life without chicken or cheese sounds challenging, take heart from the
experiences of the folks who participated in our research. They found the
transitiontobesmooth.Theyfoundtastestheylikedbetterthantheiroldgo-to
foods. And within a few weeks, they were very much in charge—not only of
theirmenusbutalsooftheirhealth.Theyfoundthatexcessweightwasalready
starting to melt away, their blood sugar was coming under control, their
cholesterollevelswerefalling,andverysoon,manystartedtocutbackon—or
evendiscontinue—theirmedications.
WhataDifference:AnimalversusPlantFoods
FAT(%OFCALORIES) CHOLESTEROL(MG)
Salmon,Atlantic
40
71
Beef,bottomround,lean* 33 86
Chicken,whitemeat,skinless 23 85
Porkloin,lean 41 81
Trout,rainbow 35 69
Tuna,white 21 42
Apple 3 0
Beans,navy 4 0
Broccoli 11 0
Lentils 3 0
Orange 4 0
Rice,brown 7 0
*Meatservingsare3.5ounces(100grams).
SOURCE:USDA,AgriculturalResearchServiceNutrientDataLaboratory,
https://ndb.nal.usda.gov/ndb/search/list,accessedApril8,2017.
ReadyforaChange
Inoneofourresearchstudies,halfthevolunteerswereassignedtoalow-fatvegandiet,and
theotherhalfwereinstructedtofollowamoreconventionaldietfordiabetes.Sinceitwastobe
anunbiasedtest,thedietassignmentwasdonebyacomputer.Sotheprocesswasrandom,
andneither the volunteersnorwehadanyinfluenceoverwho got which diet. Nonetheless,I
wascurious about howthe volunteers felt aboutthe two diets,so I asked them. If therehad
beenanopportunitytochooseoneofthediets,whichonewouldtheyhavechosen?Iexpected
mostto say they wouldhave chosen the conventionaldiet—itis familiar to mostpeople who
havebeendiagnosedwithdiabetes,andIthoughtthevolunteersmightfeelabitoftrepidation
aboutgivingupmeatanddairyproducts.
Asitturnedout,theirpreferenceswerejusttheopposite.Thevolunteersactuallypreferred
thevegandietbyabouttwotoone.Thereason,Ilearned,wasthatmanyhadalreadybeenon
aconventionaldietandhadfounditdullandnotveryeffective.Manyofthemhadheardabout
theadvantagesofavegandiet.Othershadrelativeswhofollowedavegetarianorvegandiet,
andtheywantedtogiveitatry.
Bothgroupsembracedtheirassignments.Somedidwellontheconventionaldietandsome
didnot.Theresultswiththevegandiet,however,werepowerfulandconsistent.
HowNancyandVanceDidIt
HowdidNancyandVance,whomyoumetintheIntroduction,farewiththediet
changes?
ForNancy,thechangewasawelcomeone.Shewasfedupwiththelackof
results from the previous diet she had been given and thought a vegan diet
soundedlikeagoodapproach.Shewantedtoloseweight,andshewassickof
feelingsolowonenergy.This,shehoped,mightbeananswer.
Nancy grew up in Minnesota. Her mother was not an especially talented
cook,shesays,butherScandinavianfamilylovedfood.Hermotherandsisters
allstruggledwithweightproblems.
Likemostofourstudyvolunteers,Nancyhadalreadymadehealthychanges
toherdietovertheyears.Shehadstoppedeatingbeef,ateplentyofvegetables,
and hadgotten away fromfatty dressings, so makingthe shift wasreasonably
easy.
As she began the study, she started her day with oatmeal topped with
cinnamon and fat-free vanilla soy milk. At midmorning, she liked to have a
snack,usuallyfruitsuchasapples,bananas,raspberries,blueberries,grapes,or
oranges.
Forlunch,shehadaheartyvegansoupsuchasminestrone,vegetablesoup,
sweet potato soup, or chili, along with a salad made with fresh spinach;
tomatoes;red,yellow,andorangebellpeppers;kidneybeansandchickpeas;and
other ingredients. Her afternoon snack was often fruit, rye crackers, baked
tortillachipswithsalsa,orhummusandpitabread.
Afteralongdayatwork,Nancyhadnointerestinpreparingagourmetmeal,
so her dinners were quick and easy: a veggie burger with frozen mixed
vegetables, which she microwaved. Sometimes she had nothing more than a
bowlofbrancereal.Alate-nightfruitsnackroundedthingsout.
Wegavehergroupasupermarkettourandprovidedcookingdemonstrations
tointroduce everyone tohealthful productsthat mightbe newto them. Nancy
preferredtokeepitsimpleandstartedmakingalargepotofsouptoeatallweek.
“Iamnotacook,”shesaid.“AndIfinditveryeasytostayonthisprogram.”
Vanceusually startedhisday withoatmeal,eitherplain orwithapplesand
cinnamon. He also had toast and fresh fruit. Lunch or dinner was pasta or
burritos along with fresh vegetables and fruits. Sometimes his taste called for
salads,usuallydressedupwithbeans,bloodoranges,orotheradditions.
“I had to learn to read labels,” he said. “It is easy to underestimate the
amountoffatorsugarinacanoffood.Alabelmightshow6gramsoffat,and
you might think that means the whole can. But it actually means just one
serving.”
ForVance,thevegandietwasthewaytogo.“Idon’thavethepersonality
thatwouldletmehavejustasmallpieceofchickenorasmallpieceofbeef,”he
explained.“Ihavetocutitoutaltogether.Forme,thisisalifestylechange.”
THEPOWERPLATE
For starters, let me introduce you to the Power Plate, a simple meal-planning
guidethat mycolleagues andI developed. Theidea issimple: Buildyour diet
fromfourhealthystaples—wholegrains,legumes,vegetables,andfruits.
On yourplate,these simple ingredientsmight translate into aheartysweet
potatochowder,spinachlasagna,CubanblackbeansandSpanishrice,lentiland
carrotsoup,andendlessotherpossibilities.Butlet’sfirsttakealookatthestaple
foodsthemselves.Thesearetheingredientsthatbuildhealthfulmeals.
Thewholegraingroup.Thisgroupincludesbrownrice,oats,barley,corn,
andalltheproductsthataremadefromwholegrains:breads,cereals,pasta,and
many others. In countries where grains are staples, diabetes is much less
common than it is in North America and europe. This should be no surprise:
Whole grains are filling but have very little fat and no cholesterol. When
selectinggrains,lettheGlycemicIndexguideyoutothebestchoices.
Thelegumegroup.This categoryincludes beans, peas,and lentils.It also
includestheendlessarrayofsoyproducts,fromveggieburgerstomeatlesshot
dogs,tofu,tempeh,miso,andeveryconceivablekindofdelislice.Legumesare
hearty,high-proteinfoodswitharemarkablylowGI.Theyarerichincalcium,
iron,andcholesterol-loweringsolublefiber.Whetheryoufavorachickpeasalad,
blackbeanchili,orasoy-basedveggieburgerorothermeatsubstitute,legumes
arehandyandhealthy.
The one thing the bean group lacks is good public relations. Its health
benefits have gone largely unnoticed. Nutrition scientists, however, know that
puttingthesehealthypowerhousesfrontandcenteronyourmenuisagreatway
todrivedownyourweight,bloodsugar,andcholesterol.TheUSgovernment’s
National Nutrition and Health Examination Survey showed that people who
includedbeansintheirregularmenuweighed,onaverage,6.5poundslessthan
peoplewhogenerallyneglectedthishealthyfoodgroup.
7
Thetrendshowedup
inteenagers,too.Teenagebeanloversweighed7poundslessandhadwaistlines
thatwerenearlyaninchslimmercomparedwiththeirbean-avoidingpeers.
8
ResearchersattheUniversityofTorontoconfirmedthatpeoplewhoinclude
a serving of beans, chickpeas, lentils,or peas in their daily routine are indeed
thinnerandhavelowerlevelsofLDL(“bad”)cholesterol.
9,10
If you are new to bean dishes, go easy at first, keep portions modest, and
cook them thoroughly. They are likely to cause some gassiness until your
digestivetractadapts.
The vegetable group. Each member of the vegetable group is robustly
healthful. The green vegetables—asparagus, broccoli, spinach, kale, Swiss
chard,andmanyothers—arepackedwithironand,exceptforspinach,highin
absorbable calcium. Orange vegetables—carrots, yams, and butternut squash,
amongothers—areloadedwithbeta-carotene,acancerfighter.Begenerouswith
them.
Instead of the neglected little pile of overcooked vegetables some people
park on their plates, have two or even three different vegetables with your
dinner.One of myfavorite combinationsis “orangeplus green,” asin mashed
butternutsquashandbroccoli.SometimesIcookthemupfresh,andothertimes,
I simply use frozen. The colors contrast, as does the sweetness of the squash
withtheheartierflavorofbroccoli.Youdonothavetobeagourmetchef.Even
the most hurried person has time to open a package of frozen vegetables and
steamormicrowavethem.
Thesefoodsareloadedwithvitaminsandminerals,areverylowinfat,and
likeallplantfoods,havenocholesterolatall.
VirtuallyallhavehealthylowGIs.Themainexceptionisbakingpotatoes,so
favorsweetpotatoesinstead.
The fruit group. Fruits are loaded with vitamins and, of course, have
essentiallynofatorcholesterol.Manypeoplewithdiabetesimaginethatbecause
fruitsaresweet,theywillraisebloodsugar.Thefactis,though,thatnearlyall
fruits—apples, bananas, blueberries, cherries, clementines, oranges, peaches,
pears,andmostothers—havelowGIs.
For a simple and beautiful dessert, combine blueberries with chopped
mango,papaya,orbanana.You’llthinkofmanyothergreatcombinations.
Howmanyservingsshouldyou havefrom eachgroup? Youcan varyyour
serving sizes as much as you like. If you prefer Mediterranean cuisine, your
platemayberichinvegetablesandpasta.IfAsianfoodisyourthing,yourplate
mayholdgenerousportionsofriceorothergrains.IfyouloveLatinAmerican
foods,youmightgoforbeandishes.IfyoucomefromatypicalNorthAmerican
background,youwillprobablywantavarietyofallfour.Inthenextchapter,I
willshowyousomeeasy,deliciouswaystogetstarted.
It goes without saying that the recommended foods do not include meat,
dairyproducts,eggs,orgreasyfriedfoods.
Grapefruitinteractswithmedications
Surprisingasitsounds,ifyouareoncertainmedications,youmayneedtoavoidgrapefruit.
11
A serving of grapefruit or a glass of grapefruit juice can measurably increase the blood
concentrationsof drugs you may be taking, to the point of toxicity. Here’show it works: Let’s
say you were to swallow a cholesterol-lowering drug, like atorvastatin (Lipitor). Normally,
enzymesinyourintestinaltractandliverwillinactivatesomeofit,reducingtheamountthatis
activelycirculatinginyourblood.Thisisentirelynormal,andyourdosewasdeterminedwith
thatinmind.
Butgrapefruitknocksoutthesedrug-limitingenzymes.Asaresult,youendupwithmoreof
theactivedruginyourbloodstream.Abouthalfofalloralmedicationsaremetabolizedbythese
enzymes,andevenoneservingofgrapefruithasaneffectthatlastsallday.
Forcholesterol-loweringdrugs,thisisanissueforatorvastatin(Lipitor),simvastatin(Zocor),
and lovastatin (Mevacor), but not for pravastatin (Pravachol), rosuvastatin (Crestor), or
fluvastatin(Lescol),becausetheyaremetabolizeddifferently.
Grapefruitdoesthesamefordozensofotherdrugs.Soifyouhaveatasteforgrapefruit,
check with your doctor about how it might interact with any medications you are taking. The
sameeffectcomesfromlimes,Sevilleoranges(usedtomakemarmalade),andpomelos,but
notfromtypicalnavelorValenciaoranges.Theproblemoccursonlywithoralmedications,not
injectables.
OtherPermittedFoods
Fat-freesaladdressingsandotherfat-freecondiments
Coffee(withfat-freenondairycreamer,ifdesired)
Occasionally,alcoholicbeverages
Rarely, sugar, nuts,seeds, dark chocolate(madewithout milk),full-fat soy
productssuchastofu,tempeh,soycheese,etc.
FoodstoAvoid
Meats,poultry,fish,eggs(whitesandyolks),andalldairyproducts(regular
andfat-free),includingmilk,yogurt,cheese,icecream,cream,sourcream,
butter,etc.
Added oils, such as margarine, salad dressings, mayonnaise, cooking oils,
etc.
Friedfoods,suchaspotatochips,frenchfries,onionrings,doughnuts,etc.
Avocados,olives,andpeanutbutter
FoodswithhighGIs,suchaswhitebreadorwhitepotatoes
VitaminB
12
andVitaminD
Althoughfoodswillgiveyoumostofthenutritionyouneed,twosupplements
areimportant:vitaminB
12
and vitaminD.VitaminB
12
is essentialfor healthy
nervesand healthyblood,and vitaminDis importantforyour bonesand may
reduce cancer risk. All typical multivitamins contain both and are very
convenient.Butbecausemultivitaminsalsohaveingredientsyoumaynotwant
(e.g.,iron andcopper),you caninsteadjustpickup thesetwovitamins atany
drugstoreorhealthfoodstore.You’llfindmoredetailsinChapter10.
SoupNirvana
Walter arrived at one of our research meetings to announce that he had found the perfect
lunch.HislocalsupermarketstocksalineofsoupsfromtheTabatchnickcompanythathappen
to come in several low-fat vegan varieties, such as black bean soup, split pea soup, and
vegetarianchili. Withsimple,naturalingredients, a servinghasabout200 calories andjusta
gramortwooffat.Theyareavailableinbothregularandlow-sodiumversions.Sincetheyare
frozen,theykeepmoreorlessindefinitelyandcanbemicrowavedtomakeamealinminutes.
There are also many other great brands, including Dr. McDougall’s, Health Valley, and
Amy’s,thatareeasy,quick,andhealthful.
HealthierSubstitutesforDairyProducts
Itmaysurpriseyoutolearnthatsomeofthebiggestsourcesoffatarelurkingin
the dairy section. Milk, cheese, and ice cream once enjoyed a healthful
reputationthatfewpeoplequestioned,butthathaschanged.Ithasbecomeclear
thatthesefoodsareactuallythelargestsourceofsaturated(“bad”)fatinthediet,
and also contribute cholesterol, animal protein, and, in the case of fat-free
varieties,abigloadoflactosesugar.
Here’sthelowdownondairy,followedbythegoodnewsabouthoweasyit
istoreplaceit.
Dairyfat. Cow’s milk derives, believe it or not, 49 percent of its calories
fromfat.Thatisalotbyanystandard.Youmayimaginethat2percentmilkis
muchlowerinfat.Notso.That2percentfigurereferstofatcontentbyweight,
whichisdeceptivebecauseitisthrownoffbymilk’swatercontent.Whenyou
drinkaglassofmilk,yourbodyabsorbsthatwater.Whatmattersforyourhealth
is how much fat you are left with. Nutritionists look for the percentage of
caloriesthatcomefromfatbecausethatfigureisunaffectedbywatercontent.It
turnsoutthatfor2percentmilk,about35percentofcaloriescomefromnothing
butfat.
What is particularly worrisome about milk, though, is the type of fat it
contains. Most of it is saturated fat, the very kind that is linked to insulin
resistanceand raisescholesterollevels.Dairy productsareactually theleading
sourceofsaturatedfatinthediet.
Typical yogurt, ice cream, and sour cream products are high in fat, too.
Cheeseisloadedwithit.Manybrandsderiveabout70percentoftheircalories
fromfat.
Dairysugar.Fat-freedairyproductshavehadtheirfatremoved,butwhat’s
still there may surprise you. When the fat is skimmed away, the predominant
nutrientinmilkisactuallysugar—lactose,thedairysugar.
The lactose molecule is a combination of two smaller sugars, glucose and
galactose.Approximately55percentofthecaloriesinfat-freemilkcomefrom
lactose.Peoplewhoquiterightlyavoidsodasandothersugarydrinksbecauseof
theirsugarcontentwillwanttobeawarethatmilkproductsareamajorsource
ofsugar,too.
Lactose,ofcourse,isthesugarthatcausesdigestiveupsetformanypeople.
Lactose intolerance is a normal condition that occurs when the enzymes that
allow babies to digest mothers milk naturally start to dissipate. When these
enzymesaregone,lactosepassesthroughtheintestinaltractundigested.Inthe
lower intestinal tract, bacteria start to ferment the sugar, causing gas, cramps,
anddiarrhea.Lactoseintolerancewasoncethoughttobeanabnormalitybutis
now known to be the biological norm. The symptoms come on gradually,
sometime after early childhood, and they are simply a sign that you have
successfullypassedtheageofweaning.
Dairyproteins.Theseproteinshavecomeunderscrutinyfortheirpotential
contributiontotype1diabetes,asdescribedinChapter3,buttheyareimplicated
inmanyotherhealthconcernsaswell.Animalproteinsappeartoacceleratethe
gradual loss of kidney function that can occur in diabetes.
12
Plant sources of
protein—beans, grains, vegetables, and soy products, for example—do not
appeartocausethisproblem.
People who have migraines often report improvement when they avoid
certainfoods,andmilkandotherdairyproductsareoftenatthetopofthelist.
Thesamehasbeenreportedforsomecasesofrheumatoidarthritis.Theproblem,
itappears,isnotthefatorlactose,atleastnotfortheseconditions.Thetrigger
seemstobethedairyproteins.
Dairy products are linked to other health problems ranging from acne to
prostate and ovarian cancer. It is the latter issue—cancer—that has gotten the
attention of the medical community. Two large Harvard studies and several
studies from other countries have shown that milk-drinking men have a
significantly higher risk of prostate cancer compared with men who generally
avoiddairyproducts.
13–16
Intryingtoexplainthisassociation,researchershave
pointedfingersatmilk’shormonaleffects,aswellaspotentiallyharmfuleffects
ofitshighcalciumandphosphatecontent.
17
Forovariancancer,theevidenceis
mixed,withsomestudiesshowing higherrisk amongmilk drinkersand others
showingnoincreasedrisk.
18,19,20
milk’s selling point has been the calcium it provides. There are, however,
bettercalcium sourcesand moreeffectivewaysof maintainingstrong bones.I
willgointomoredetailaboutthislaterinthechapter.
Makingbetterchoices.Peoplewhoavoiddairyproductsfindnoshortageof
great substitutes. Health food stores and regular supermarkets stock soy milk,
rice milk, almond milk, and many others. They come in regular, calcium-
fortified, and low-fat varieties and in plain vanilla, chocolate, and strawberry
flavors.Youwillwanttochoosethoselowestinfatandsugar.Calcium-fortified
juices have arrived on the market, too. Of course, none of these is necessary.
Aftertheageofweaning,theonlybeveragethatisactuallybiologicallyrequired
iswater.Notsoda,notjuice,notmilk—justpurewater.
Therearemanydeliciousnondairy icecreamsubstitutesmadefrom soyor
ricemilk.Inmanycases,however,themainreasontheyaresodeliciousisthat
theycontainaddedsugar.Yourtastebudscanbeeasilyseducedbythesetreats,
butyourbodywouldbefarbetteroffwithabowlofstrawberries.
AlternativestoEggs
Therearejusttwoproblemswitheggs:theyolkandthewhite.Theyolkiswhere
cholesterollurks,witharound200milligramsinasingleegg.That’ssimilarto
an8-ouncesteak.
Theyolkalsoholdsthefat,about5gramsperegg.Eggwhitehasproblems
of its own, since it is essentially pure animal protein. As you know by now,
animal protein can present problems for your kidneys, and you are better off
withplantprotein.
Cantherereallybeallthatfat,cholesterol,andanimalproteininsideasingle
egg?Certainly.Keepinmindthatwhenanegghatches,ababychickemerges.
Thatchick’s body—legs, wings,skin, feathers,internal organs, and everything
else—was formed from what was inside the egg when it was laid. So it was
loaded with cholesterol and other things you do not want. Like all animal
products,eggshavenofiberatallandnocomplexcarbohydrate.
Thereareplentyofgreatwaystoreplaceeggs,whetheryouarehookedon
scrambled eggs for breakfast or baked goods that include eggs. Try these
substitutes.
Ifarecipecallsforjust1or2eggs,leavethemout.Addacoupleofextra
tablespoonsofwaterformoisture.
Eggreplacementpowdersareavailableinmanyhealthfoodstores.
Use1heapingtablespoonsoyflourorcornstarchplus2tablespoonswaterto
replaceeachegginbakedproducts.
Tryanegg-sizepieceofmashedtofuinplaceofeachegg.
Halfamashedbananacanbeusedinmuffinandcookierecipes,althoughit
willprovideitsownflavor.
Formeatlessloavesandveggieburgers,useanyofthefollowingtobindthe
ingredientstogether:tomatopaste,mashedpotato,moistenedbreadcrumbs,
orrolledoats.
Forabreakfastdishtoreplacescrambledeggs,scrambledtofuhasbecome
popular.Tofuhasatextureverymuchlikeeggwhiteandtakesontheflavor
of whatever it is cooked with. Be wary of products promoted as no-
cholesterol egg replacements; many are simply egg whites with various
addedingredients.
2.KEEPVEGETABLEOILSTOAMINIMUM
Oilscreepineverywhere,itseems:cookingoils,saladoils,vegetableoilsused
in baking and in snack foods.Vegetable oils do enjoyabetter reputation than
animal fat, and indeed, they have less saturated fat—the kind that raises
cholesterollevels.Butwestillwanttokeepalloilstoaminimum.Hereiswhy.
First,aswesawabove,allfatsandoilsareloadedwithcalories.Theyhave9
caloriespergram,whichismorethantwicethecaloriecontentofcarbohydrate
or protein (4 calories per gram). Thus, when it comes to calorie content,
vegetable oils are as fattening as lard. All fats and oils are in fact equally
fattening.
Second,ifyourgoalistoregainasmuchinsulinsensitivityaspossible,you
will want to eliminate not only animal fats but also added vegetable oils.
Cleaning the animal fat out of your cellular “locks” does no good if you are
goingtoclogthemwithvegetablegrease.Herearethesourcesoftheseoils.
Friedfoods.Frenchfries,potatochips, onionrings, andotherfriedsnacks
are essentially sponges carrying grease from the deep fryer to your body fat
stores.
Addedoils.Typicalsaladdressingsandmargarineshavelotsoffat.
Oils used as ingredients. Many packaged foods and sauces include
significantamountsofoil.
Oils used in sautéing. Many recipes begin with the instruction to sauté
onions,garlic, orotheringredients inoil. Somerestaurantsuse oilalmostas a
staple.
Thereareeasywaystoavoidallthatgrease.
Steerclearoffriedsnackssuchaspotatochipsandfrenchfries.
Top salads with fat-free dressings, lemon juice, balsamic vinegar, or
seasonedricevinegar.
Usenonstickpans.
Steam-fry onions, garlic, or vegetables in water or another cooking liquid
insteadofsautéingthetraditionalway.
Steamvegetables.
Inplaceofpouredoils,considerusingcookingspray.Ifyouusejustaquick
spritz,theamountofaddedoilistrivial.
Usefat-freenondairycoffeecreamer.
Readpackagelabels.Lookforproductswithnomorethan3gramsoffatper
servingorwithapercentageofcaloriesfromfatofbelow10percent.
Whenitcomestoavoidinggreasyfoods,somepeopleareeagertomakean
exceptionfor olive oil.It seemsnaturaland evenchic. But thinkfor asecond
about how factories manage to fill a bottle with oil. They take an enormous
numberofolives,discardtheirfiberandpulp,andleaveyouwiththefat.
Gramforgram,oliveoilhasthesamenumberofcaloriesasbeeffat,chicken
fat,andotherfatsandoils—thatis,9caloriespergram.Nootherfoodismore
calorie dense. While olive oil contains a great deal of monounsaturated fat,
whichhaslittleornoeffectoncholesterol,italsocontainssaturatedfat(about
14percent),thekindthatincreasescholesterolandworsensinsulinresistance.It
doesnotmatterhowexpensivetheoilisorhow“extravirgin”itmaybe.Itstill
has more calories and saturated fat than your body is designed to process to
maintainoptimalhealth.
There are, of course, traces of natural vegetable oils in vegetables, fruits,
beans,andgrains,butyouneednotworryaboutthem.Yourbodydoesneeda
tinyamountoffat,andplantsprovideitnaturally.Werunintoproblemswhen
oils are concentrated, as they are in fried foods, oily sauces, and recipes with
addedoils.
A few plant foods, such as nuts, seeds, olives, avocados, and some soy
products, are naturally high in oil. If you are trying to lose weight or tackle
diabetes,youwillwanttoavoidthem.
WhataboutGoodFats?
Therearetwotypesoffatyourbodyactuallyneeds.Theirtechnicalnamesare
alpha-linolenic acidand linoleic acid. These terms are not important; you will
neverseethemonaningredientslist.Whatisimportanttoknowisthatyouneed
onlyatinyamountofthem.Thebody’sneedfortheseessentialfatsisnomore
than2to3percentofyourdailycalorieintake.
Wheredo youfind them?Beans,vegetables, andfruits arevery lowinfat
overall,butthetracestheydocontainarerelativelyrichin“good”fat—thatis,
alpha-linolenicacid.Thisisthebasicomega-3fatthatyourbodyusestoproduce
othergoodfats.Nuts,seeds,andsoyproductscontainlargeramounts.Linoleic
acidisfoundinmanyplantfoods,too.
Somepeopleboosttheomega-3fatsintheirdiets.Ifyouaredoingthis,be
careful:Allfats, goodandbad, areequallyfattening,and manycontainthings
yourbodydoesnotneed.Fishoil,forexample,containsplentyofsaturatedfat
alongwithitsomega-3s.
Thebestwaytogettherightkindandamountoffatinyourdietistoskip
animalproducts,friedfoods,andoilyfoodproductsandgetyournutritionfrom
vegetables,fruits,beans,andwholegrains.
Does it really matter whether or not we avoid animal products and added
oils?Absolutely.AtypicalNorthAmericanorEuropeandietmightprovide80to
100gramsoffatperday,orevenmore.Switchingfrombeeftochickenandfish,
keeping portions modest, and limiting added oils will trim this to about 60
grams.Butsettinganimalproductsasideandavoidingaddedoilscandropthis
number to close to 20 grams. In the process, your cholesterol intake, which
wouldbewellover200milligramsperdayonanunmodifieddiet,willdropto
zero.Everycellinyourbodywillthankyou.
3.FAVORFOODSWITHALOWGLYCEMICINDEX
You will find this third guideline very useful. The glycemic index (GI) is a
handytoolthatwasinventedbyDavidJenkins,MD,PhD,DSc,aphysicianand
researcher at the University of Toronto.
21
It is simply a number that indicates
howrapidlyanygivenfoodreleasessugarintothebloodstream.Afoodwitha
highGIreleasessugarintothebloodquickly.
One example is white bread. If a molecule of carbohydrate in bread was
greatlymagnified,itwouldlooklikeastringofbeads.Eachbeadisamolecule
of sugar (glucose). In your digestive tract, these beads separate and pass into
yourbloodstream.
With white bread, this process is quick. The string of beads rapidly
disintegrates,andtheindividualglucosemoleculesraceintoyourbloodstream.
Ifyouweretocheckyourbloodsugaraftereatingthebread,youwouldseethe
result.WhitebreadhasahighGI,meaningithasapronouncedeffectonyour
bloodglucose.
Incontrast,pumpernickelbreadhasalowGI.
*
Its“beads”comeapartmore
slowly,passingintothebloodstreambitbybit.Ithasmuchlesseffectonyour
bloodsugar.
Inanutshell,high-GIfoodstendtohaveagreatereffectonyourbloodsugar,
andlow-GIfoodshavelesseffect.
IshouldmentionthatwhenresearchersmeasuretheGIofindividualfoods,
theytestvolunteerswhodonothavediabetes,soafoodthatdoesnotraisetheir
bloodsugarverymuchcouldraiseyourssomewhatmore.However,thepointof
theglycemicindexistoallowustoratefoods—tocompareoneagainstanother
—sowecanchoosethebestones.
IfyouweretodoanonlinesearchforinformationabouttheglycemicIndex,
you would soon discover a mind-numbing array of tables from a variety of
sources,noneofwhichagreewitheachother.ThatisbecausetheGIofanyfood
can vary depending on the brand, how it was prepared, and other factors. So,
let’skeepthingssimple.HereisallyouneedtoknowabouttheGI:
GlycemicIndexataGlance
White and wheat breads are high GI. Rye and pumpernickel are better
choices.
TablesugarishighGI.Fruitsarebetter.Theygiveyouasweettastewitha
suprisinglylowGI.
WhitebakingpotatoesarehighGI.Sweetpotatoesarelower.
MostcoldcerealsarehighGI(especiallyiftheyhaveatoyinsidethebox).
Oatmealandbrancerealsarebetter.
Andhereareafewmoretips,forextracredit:
Beansandtheirrelatives(lentils,peas)arealwayslowGI.
GreenleafyvegetablescanalsobeconsideredlowGI(althoughtheyhaveso
littlestarchthattheirGIstypicallyhavenotbeencalculated).
Pastaisalow-GIfood.Becausepastaiscompacted(unlikebread),itdigests
slowlyandreleasesitsnaturalsugarsonlygradually.Moreonthisbelow.
Barley,bulgur,andparboiled(converted)riceallhavealowGIvalue.
Now,ifyouhavetype2diabetes,anyfoodwithcarbohydrateinitwillpush
yourbloodsugaruptoadegree.Infact,ariseinbloodglucoseafteramealis
normal,andifyourcellsareinsulinresistant,ittakesabitmoretimeforglucose
inyourbloodstreamtopassintoyourcells.Thisdoesnotmean,however,that
youshouldavoidfoodsthatcontaincarbohydrate.Whatitmeansisthatyouwill
wanttotakestepstoreduceyourinsulinresistance,asoutlinedinthischapter.
Amongcarbohydrates,thebestarethosewithalowGI.
ThereasonImentionthisisthatsometimespeoplewithtype2diabetesshun
carbohydrates. They avoid rice, beans, pasta, and all the rest and load up on
chicken,fish,andeggsbecausethesefoodshavenocarbohydrate.Butoverthe
longrun,theyfindtheirbloodsugardoesnotimprove;theirlevelgetsworse,so
they need more and more medicine.It makes sense when you think about the
factthatthesefoodscontributealoadoffatandaggravatetheaccumulationof
fat in cells—more gum in the locks, so to speak. Greasy meals today mean
insulinresistancetomorrow.
ItmaysurpriseyoutolearnthatpastahasalowGI.Itdoes,particularlyifit
isservedaldente,thatis,notovercooked.Ofcourse,pastaismadefromwheat
flour, so you may think it would spike your blood sugar in the same way as
wheatbread.Butthatisnotthecase.
Pasta actually gives us a little lesson in why some foods have a high GI,
whiletheGIofothersislow.
Let’ssaywearemakingbreaddough.Weaddabitofyeasttotheflourto
makethebread rise.Theyeastcauses manytinyairpocketsto form,whichis
what makes bread different from, say, a shingle. Now, as you eat the baked
bread, your stomach acid and digestive enzymes enter those air pockets and
rapidly break the molecules of flour into individual sugar molecules that then
passfromyourdigestivetractintoyourbloodstream.Evenwholewheatbread,
with shreds of fiber remaining, is easy pickings for digestive enzymes—they
havenodifficultyenteringtheairpocketsanddigestingthestarchinthebread.
pastaisdifferent.Itisnotmadewithyeast,soithasnoairpockets.Ifbread
islikeapileoftinytwigs,readytoignitewithasinglespark,pastaislikeacord
oflogs—itismuchmorecompactedand“catchesfire”moreslowly.Evenifyou
chew pasta thoroughly, there is no way it can digest as rapidly as bread—and
that’swhyithasalowerGI.
Thetake-homelessonisthatprocessingfoods—pulverizinggrainsintoflour
or using yeast to make dough rise, for example—starts the digestive process
beforeyouevenputthefoodonyourplate.Anintactgrainisslowtocomeapart
and release glucose into your bloodstream, while a heavily processed grain is
likely to disintegrate quickly. Thus, old-fashioned oatmeal, which consists of
wholeoats,hasalowGI.Butquick-cookingoatmealismadebyslicingtheoat
grainsintofragments.Thatallowsittocookfasterandtodigestfaster—which
meansahigherGI.
IfyouwouldliketolookuptheGIofindividualfoods,youcantakealook
at a Web site established at the University of Sydney in Australia:
glycemicindex.com.Justtypeinthenameofthefood,andallthetestingresults
willappear.
“Doesitreallymatter?”youmaybeasking.“Canitreallymakeadifference
ifmyoatmealisold-fashionedinsteadofinstant,orifIbringbeans,greenleafy
vegetables, and barley soups into my life?” Jennie Brand-Miller, PhD, of the
UniversityofSydney,answeredthatquestionbyanalyzingthecombinedresults
of14studiesontheglycemicindexthatincludedatotalof356participants.She
found that choosing low-GI foods reduces hemoglobin A1C by 0.3 to 0.4
percentage point. In some studies, the difference was as much as 0.6 point.
23
Studiesshowedasimilarbenefitforbothtype1andtype2diabetes.
This advantage is over and above that of the other diet changes you are
making. As you will remember from Chapter 2, the combined diet changes
described inthis book—avoiding animal products,minimizing oils, and eating
low-GIfoods—addeduptoanA1Cdropof1.2percentagepoints,onaverage,in
ourresearch.Thataverageincludespeoplewhodidnothaveveryfartodropas
wellassomeparticipantswhostartedwithA1Csinthe9to10percentrangeand
dropped several percentage points. These results are stronger than any single
drugislikelytobring.Forsomepeople,thatisallittakestoreturntheirA1Cto
thenormalrange.
TWOIMPORTANTSUPPLEMENTS
Fruits, vegetables, beans, and grains provide the healthy nutrition you need.
Eating these foods, you are much better nourished than you would be on a
meaty,dairy-filleddiet,becausethesehealthy,plant-basedfoodsarerichinfiber,
vitamins,andotherplant-basednutrients,whilehelpingyouskipunhealthfulfats
andcholesterol.Evenso,therearetwosupplementsthatareimportantforyouto
knowabout.
VitaminB
12
.VitaminB
12
isessentialforhealthynervesandhealthyblood
cells. If your B
12
level runs low, you could have nerve symptoms that are
permanent. But this vitamin is not made by animals or plants. Rather, it is
producedbybacteria.Howdoesthissubstancegetfrombacteriatothehuman
body? Some have suggested that before the advent of modern hygiene, there
weretracesofbacteriainthesoil,onvegetablesandfruits,onourfingers,orin
ourmouthsthatprovidedthetinytracesofvitaminB
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thatweneed.Whether
thatwasevertrue,itiscertainlynotareliablesourcetoday.Bacteriainanimals’
intestinaltractsproducevitaminB
12
,andtracesofitendupinmeatandother
animal products. The problem with these sources is that along with it come
cholesterol,fat,andanimalproteins.B
12
isalsoaddedtosomefoods,asyouwill
sometimes see on the package labels of breakfast cereals, soymilk, nutritional
yeast,and otherproducts.The bestsourceis avitaminB
12
supplement, which
youwillfindatanydrugstoreorhealthfoodstore,andyoushouldtakeitdaily.
Thedoseisnotespeciallyimportant,becauseallcommonbrandshavemorethan
therecommendeddailyallowance,andevenhighdosesofB
12
donotappearto
bedangerous.
Vitamin D. Technically, vitamin D is not a vitamin at all. It’s actually a
hormone produced by sunlight on your skin. Once activated in your liver and
kidneys,ithelpsyouabsorbcalciumandhelpsprotectyourcellsagainstcancer,
amongotherfunctions.
Ifyougetplentyofsun,youdonotneedanyvitaminDinyourdiet.Butif
you do not get regular sun exposure, a vitamin D supplement is important. A
reasonabledailydoseis2,000IU.
PUTTINGTHERIGHTFUELINYOURTANK
Nowwehavecoveredthebasics,thethreeguidelinesthatworktogethertohelp
you regaincontrol: avoidinganimal products,keepingoils toa minimum, and
favoringlow-GIfoods.
These guidelines work together. Meeting one of them is not enough. For
example, jelly beans can be vegan, and they are low in oil. Because they are
essentiallysolid sugar, though,they have ahigh GI andwill spike yourblood
glucose.
Similarly,asnackcakeloadedwithbuttercanhaveaverylowGIbecause
butter contains no carbohydrate and may even slow the absorption of glucose
youeat.Butthesnackcakeisnotvegan,norisitlowinfat.Itwillcontributeto
insulinresistance,andyouwanttosteerclearofit.ThelowGIisnotareasonto
eatitifitdoesnotmeetourothercriteria.
Thethreeguidelinestogetherareapowerfulcombination.Nancy’sA1Cwas
8.3percentatthebeginningofourstudy.Asshebeganthehealthydietchanges,
it rapidly slid under 7.0, even while she reduced her medications. For Vance,
initialA1Ctestingshowedavalueof9.5percent,butastheweekswentby,it
dropped and dropped and dropped. By the study’s conclusion, his A1C was a
healthy5.3percent.
Now,beforeweplanoutyourbreakfast,lunch,anddinner,letmeshowyou
howthesethreeprinciplestranslateintochangesinsideyourbody.Justasacar
performsdramaticallybetterwhenithasthefuelitwasdesignedfor,yourbody
performsfarbetterwhenyougiveitthefoodsitneeds.
Increasedinsulinsensitivity.Asyouknowbynow,evidenceshowsthata
dietchangecanhaveaquickanddecisiveinfluenceontheamountoffatinside
your cells. As the amount of fat drops, your cells become more and more
sensitive to insulin, allowing your blood sugar to come down. If your insulin
resistancewaspreviouslyworseningandyourmedicationdosesincreasing,the
processbeginstoreverse.
Thiscanhappenremarkablyquickly.Infact,itcanhappensoquicklythatit
isessential,ifyouareusinginsulinoranydrugthatincreasesinsulinsecretion
(forexample,glipizide,glimepiride,glyburide,nateglinide,orrepaglinide),that
you be in close touch with your doctor. As your cells regain their insulin
sensitivity,youwillbecomemoreandmorelikeahealthypersonwhoistaking
drugsheorshenolongerneeds.
Thecombinationof ahealthydietand thedrugsyouhave beentakingcan
drive your blood sugar down to healthful levels and then below them, to
hypoglycemia.Inotherwords,yourbloodsugarcanfalltoolow,whichcanbe
dangerous. Your doctor will lower your medication doses or even discontinue
yourmedicationsasnecessary,whichwillsolvetheproblem.Now,donotthrow
yourmedicinesawayonyourown.Yourdoctorwillguideyou.Anddonotbe
frightenedbythisreturntohealth.Itisawonderfulfeelingtodiscoverthatyour
insulinsensitivityisimprovingdaybyday.Whenyourdoctorsaysit’stimeto
cut back on medication or stop a drug altogether, it is as if time is moving
backward.
Chapter7 has importantdetails on how to prevent and treathypoglycemic
episodes.Pleasereaditcarefullybeforeyouchangeyourdiet.
Easyweightcontrol.Ifyouhavebeenhoping tolose weight,that process
hasjustbegun.Onaverage,thedietyouarebeginningcausesaweightlossof
about1poundperweek.Astimegoeson,itaddsuptoanimpressivechange.
“Howdoes thiswork?”you mayask. Howcanyou loseweightif youare
payingnoattentionatalltoportionsizes,calories,andcarbohydrates?Thereare
threemainreasons.
First,thefoodshaveverylittlefat,soyouareeliminatingthemainsourceof
unwantedcalories.
Second,thevegetables,fruits,beans,andwholegrainsyouarebringinginto
your diet give you a healthy dose of fiber, which is filling enough to turn off
yourappetiteabitsoonerthanwouldhappenwithoutthem.Onaverage,each14
grams of fiber cuts about 10 percent off your calorie intake. A person who
normallyeats2,000caloriesperdayandthenstartstoaddanextra14gramsof
fiberdailywilltendtofeelfullaftereating1,800calories.
24
Third, these foods cause a slight boost in your after-meal calorie burn.
Normally,youburncaloriesfasterafteramealduetotheprocessesofdigestion.
Ourstudieshaveshownthatalow-fatvegandietincreasesthisafter-mealburn,
givingyouanextraedge.
25
IwillgooverthisinmoredetailinChapter6.For
now,justenjoytheweightcontrolthatiskickinginonitsown.
Losingexcessweight feelsgreat,of course,butweight lossimprovesyour
insulinsensitivityinadditiontotheeffectsofthedietchangeitself.
Easy cholesterol control. If you have had a cholesterol problem, the
programyou are nowbeginning is farmore powerfulthantypical cholesterol-
lowering diets. This should be no surprise. Your new diet is not low in
cholesterol; it has no cholesterol at all. It also has no animal fat, which is
important because animal fat (like other sources of saturated fat) encourages
yourbodytomakecholesterol.Theyareallgonenow.Youhavereplacedthem
withcholesterol-lowering oats,soy,and other botanicalmagicians,as youwill
seeinmoredetailinChapter12.
Yourarteriesarestartingtobreatheasighofrelief.Thedamageofdiabetes
isdonetothearteries,forthemostpart,leadingtoproblemsinyourheart,eyes,
kidneys,andnerves.Butnow,youareinhibitingthatprocess,andbringingyour
cholesterolleveldown ispartofit. You arefollowingthe kindofdiet usedin
programstoreverseheartdisease.
Again, do not throw your medications away and cancel your doctor
appointments.Yourdoctorcansizeupyourhearthealthandtrackyourprogress.
Reversingsymptoms.AteamofCaliforniaresearchersusedalow-fatvegan
diet,combinedwithexercise,inagroupof21peoplewithtype2diabetes,allof
whomhadpainfulneuropathy—thenervesymptomsthatariseasthenervesare
damaged.Injust2weeks,17ofthe21reportedcompletecessationoftheirnerve
symptoms,andtheremaining4hadnoticeableimprovements.
26
Soourresearch
teamdidatestofalow-fat,vegandietalone—withoutexercise—andfoundthat,
indeed,itcanimprovenervefunctionandreduceneuropathysymptoms.
27
otherresearchershavefoundthatsomeofthechangesintheeye—exudates
in the retina—that sometimes occur in diabetes start to improve or even
disappearwhenpeoplemakeahealthydietchange.Thelossofproteinthrough
the kidneys can also diminish. You will find more details on all of these in
Chapter13.
FIRSTSTEPS
Oneofthethingswehavecarefullytestedwiththisprogramishowpeoplefeel
aboutit.Bottomline:Althoughyouwillbemakingmajorchangesinyourmenu
thataredesignedtobring youuncompromisedgoodhealth,this isperhaps the
easiestdietchangetostickwithoverthelongrun.Partly,thatisbecauseitisnot
a“diet.”Itisadifferentwayofregardingfood—amuchbetterwayofthinking
aboutandenjoyingit.Also,youwillnevergohungryandneverteaseyourself
withminusculeportionsoffoodsyoulove.
Letmeshowyouthestepsthatmakeitthatway.Forthemoment,youare
notactuallygoingtochangeanything.Ijustwanttowalkyouthroughthesteps
thatwillgetyoustarted.
Step1:CheckOutthePossibilities
Before you jump into a new way of eating, take a week and check out a few
recipesandnewfoodproducts.Lookthroughthenextchapterforideas.Youwill
findagreatmanypossibilitiestogetyoustarted.Ifyourarelycookandtendto
eatatrestaurants,thenextchapterwillhavemanytipsonthingsyoucanlook
for.
Your goal is to identify healthy breakfasts, lunches, and dinners that you
reallylike.Thatmeansmealsthatmeetallofourguidelines(noanimalproducts,
minimalvegetableoils,andlowGI)andappealtoyourtastes.
Remember that this new way of eating does not mean making a new dish
every night. William Castelli, MD, former director of the Framingham heart
Study, usedtosaythatmostofustend tostickto ourfavoritemeals.Wemay
havefourorfivedifferentdinnerswelike,andwepickfromthatrepertoirenight
afternight.Allyouneedtodoistofindhealthymealsthatsuityourtastes,and
youareset.Aweekismorethanenoughtimetodothat.
Step2:Pick3Weeks
Somepeopleliketoeasetheirwaygraduallyintoahealthierdietpattern.Ifyou
are among that group, go ahead and take your time getting to know healthier
foods.ButIadviseadifferentapproach.Marka3-weekperiodonyourcalendar
when you plan to embrace this program. Before you reach your start date,
identifymealsthatfitourcriteriaandappealtoyou.Whenthestartdayarrives,
commityourselfcompletelyfor21days.
AsItellourresearchparticipants,thisisnotthetimetostickyourtoeinthe
swimmingpool;it’stimetojumpin.Reallydoit.Makeitalllow-fatvegan,all
thetime.Therearetworeasonsforthis.
First, it gives you fast results. If you have a healthy meal on monday and
anotheronSaturday,yourbodywillnotnoticeanydifference.Butifyoudoitat
everymeal,gainscomequickly.Giveyourselfachancetoseehowitfeelstobe
onasperfectadietaspossible.
Thesecondreasonisthatadietchangereallyislikegettingintoaswimming
pool.Ifyoueaseyourwayintothewaterbitbybit,itisapainfulprocess.Butif
youplungein,verysoonyouseethatthewaterfeelsfine.Letmeexplain.
Didyoueverswitchfromwholemilktofat-freemilk?Ifyouarelikemost
people, that first glass of fat-free seemed watery and maybe even discolored.
After a couple of weeks, though, you became totally used to the lighter taste.
Beforelong,wholemilkseemedthickanddistasteful.
Now, I am not suggesting that fat-free milk is a health food. As you have
seen,there are goodreasons toavoid it.But when youlighten your diet,your
tastesrapidlychange.Verysoon,youcometopreferthenew,healthiertaste.
You will find that your taste buds have a memory of about 3 weeks, and
jumping into the diet change allows them to adjust quickly. Instead of pining
overtheunhealthyfoodsyouhaveleftbehind,youwillbesurprisedtofindthat
youmissthemverylittle.
Ifa100percentdietchangesoundslikeatallorder,letmemakeitabitmore
approachable.Youdonotneedtocommittoitforever;youjustneedtogiveita
try. At this point, there’s no need to swear off bacon double cheeseburgers,
pledgeyourloyaltytooatmeal,ormakeanyotherdauntingpromises.Justgiveit
3weeks.Duringthattime,reallydoit100percent,andyouwillgetagoodsense
ofwhatthedietwilldowhilestillkeepingallyouroptionsopen.
GETTOKNOWTRANSITIONFOODS
Modern technology has brought us plenty of modern annoyances (ringing cell
phones, crowded freeways,and junk e-mail), but once in a while,it’s actually
useful. The food industry has managed to mimic unhealthy foods with more
healthfulvarieties.
Thehotdog,longreviledbynutritionists,gainedameasureofrespectability
once food scientists figured out how to transform soybeans into a frankfurter.
Veggie hot dogs, veggie burgers, and veggie sausages debuted in health food
stores but are now sold everywhere. Even deli salami, turkey, chicken, and
bolognasliceshavesoyorwheatcounterpartsthatlookandtasteverymuchlike
therealthing,withzeroanimalfatandcholesterol.
Thesefoodsarehardlythepinnacleoffinedining,buttheyarepractical.If
youhavechildren,theyareanabsolutegift.Ifyousawwhatgoesintoarealhot
dog, it would become the last thing you would want to see heading for your
child’smouth.Butaveggieversionissomethingyoucanbringhomewithpride
—andyourkidswilllovethem.Theseproductshelpyouthroughthetransition
toabroaderrangeofhealthyfoods.
Soymilkhasarrivedbigtime.Once,buyingsoymilkmeantshoppingata
healthfoodstorethatwasdingy anddark. Thecashier waswearingatie-dyed
shirt,hisnamewasSunshine,andfolkmusicwasplayinginthebackground.
Well,thosedaysaregone.Healthfoodstoresarebigbusinessesthatknowa
thing or two about customer service. Regular supermarkets stock dozens of
flavors of soy milk, along with rice milk, almond milk, oat milk, and other
varieties,too,andpeoplefromallwalksoflifeenjoythem.
Asyoushopformeatanddairysubstitutes,takealookatthelabels.When
youchecktheingredientlists,youwillseethatsomeproductsarenotquiteas
vegan as you might like because they include egg whites or dairy proteins.
Choosetheveganversions,andlookforthosethatarelowestinfat.
COMPLETENUTRITION
When youfollow the nutritionguidelines inthis chapter, yourdiet is likelyto
improvedramatically.
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Notonlywillyouskipalltheanimalfatandcholesterol,
youwillgetmuchmoreofthehealthynutrientsyourbodyneeds:solublefiberto
cutcholesterol,healthyvitaminstoreducecancerrisk,potassiumtolowerblood
pressure,andantioxidantstoknockoutfreeradicals,tonameafew.
Evenso,youaremakingabigchange,andyouarelikelytowonderwhether
you are missing out on anything. Let me offer a word of reassurance. If you
choose your meals from a variety of whole grains, legumes, vegetables, and
fruitsandtakemyadviceaboutvitaminB
12
andvitaminD,above,youwillhave
yourbasescovered.
here’swherethehealthynutrientsareonyourplate.
Protein.Yourbodyusesproteintobuildandrepairbodytissues.Proteinsare
made upofsmall molecules called aminoacids. All the proteinsin your skin,
muscles,bones,andinternalorgansarebuiltfromvariouscombinationsofabout
20differentaminoacids.
Ahealthydietofbeans,grains,vegetables,andfruitsprovidesalltheprotein
you need. In fact, you are betteroff getting protein fromplant sources. While
animalproteincanbehardonthedelicatetissuesofthekidneys,plantproteins
appeartobefreeofthisproblem.Theyarealsofreeoftherisksofcalciumloss
and kidney stones associated with animal protein.
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Animal protein tends to
cause calcium to pass through the kidneys and into the urine. In the process,
calciumisnotonlylost,butitendsupinyoururinarytract,whereitcancause
stones.
Inyearspast,somenutritionistsbelievedthatvegetariansneededtocarefully
combinevariousfoodsinordertogetadequateprotein.Theideawasthatfoods
fromplantsmightbemissingoneormoreaminoacids,soonlycombiningfoods
incertainwayscouldensurethatyougotthemall.Thisnotionwassetasidelong
ago.TheAcademyofNutritionandDietetics’officialpositionstatementsmake
itclearthatplant-baseddietsprovideplentyofproteinwithoutcombiningfoods
in any particular way.
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If, for any reason, you wish to increase your protein
intake, turn to the bean group. You will find extra amounts of protein in soy
products, such as tofu, tempeh, and soy milk, and in wheat derivatives (e.g.,
seitan)usedtomakemeatsubstitutes.
Calcium.Formanypeople,calciumandmilkarealmostsynonymous.They
thinkthatmilkwillbuildstrongbonesandprotectagainstfractureslaterinlife.
Researchhasshown,however,thatmilk’sbenefitsare,forthemostpart,amyth.
Studiesdo notshowmuch benefitfor thebonesfrom drinkingmilk. Howcan
thatbe?Well, onlyaboutone-thirdof milk’scalciumisabsorbed bythebody.
The other two-thirds simply passes out with the wastes. In addition, milk
containsanimalproteinandsodium,bothofwhichtendtoincreasecalciumloss
throughthekidneys.
Donotmisunderstandmehere—youneedsomecalciuminyourdiet,butit
shouldcomefromhealthfulsources, namelygreen leafyvegetablesandbeans.
While there is somewhat less calcium in broccoli than in milk, the absorption
fraction—thepercentagethatyourbodycanactuallyuse—ishigherforbroccoli
andnearlyallothergreensthanformilk.Thereisoneexception:Spinachishigh
incalcium,buttheabsorptionfractionisverylow.
Greens and beans will give you the calcium your body needs. If you are
looking for extra calcium for whatever reason, you can find plenty more in
fortifiedjuicesandsoymilks.
Tomaintaincalciumbalance,however,itisimportantnotonlytotakeinan
adequateamountbutalsotominimizelosses.Animalproteincausesyourbody
tolosecalciumthroughthekidneys,anditcanbemeasuredintheurine.Studies
of high-protein diets, such as the Atkins Diet, dramatically demonstrate the
losses: Suchdiets increased calciumloss by morethan 50 percent.
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It is also
important to limit sodium (salt) and get vitamin D from either sunlight or
supplements. Vegetables and fruits promote bone strength for reasons that are
notentirelyclear,andexercisegivesyourbonesareasontolive.Itisastrong
determiner of bone health. Finally, it is also important to avoid tobacco, since
smokingincreasesfracturerisk.
Iron. Iron is a double-edged sword. You need iron to build hemoglobin,
whichyour red bloodcells use tocarry oxygenfrom your lungsto your body
tissues.Buttoomuchironcanbetoxic.Itcanincreasetheriskofheartproblems
andmayevenworseninsulinresistance.
Iron encourages the production of unstable molecules called free radicals,
whichcandamageyourbody’sdelicatetissuesandarelinkedtoheartdisease,
cancer,andevencertainaspectsoftheagingprocess.
Themosthealthfulironsourcesarethesamefoodsthatbringyoucalcium:
beansandgreenleafyvegetables.Theyarerichinironbutcarryitinaspecial
formcallednon-hemeiron.Yourbodyeasilyabsorbsthisformwhenit’sinneed
ofmoreiron,buttheironpassesharmlesslyoutofthebodywhenyouhaveall
youneed.Incontrast,meatscontainhemeiron,whichislikeanuninvitedguest
atyourparty:Itbargesinwhetheryouneeditornot.Overthelongrun,meat
eaterstendtoaccumulatetoomuchiron.
Ifyouareanemic,donotrushoutandbuyironsupplements,orworse,add
lotsofmeattoyourdiet.Instead,workwithyourdoctortofindoutwhatkindof
anemiayouhaveandwhyitoccurred.Anemiacanbeasignofkidneydisease;it
can be caused by certain drugs; and it can be a sign of blood loss from your
digestive tract caused by gastrointestinal irritation or even colon cancer. It is
essentialthatyoubeevaluatedandtreatedappropriately.
If you do need extra iron, turn first to greens and beans. Vitamin C–rich
foods, such as fruits and vegetables, increase the absorption of iron from the
otherfoodsyoueat,andavoidingdairyproductshelps,too.Theyareverylowin
ironandactuallyreduceitsabsorptionfromyourdigestivetract.
Zinc. Zinc plays important roles in immune function, wound healing, and
manyotherbiologicalfunctions,butaswithiron,you canhavetoomuchof a
good thing. The most healthful sources include legumes, nuts, and fortified
breakfastcereals(e.g.,PostGrape-Nuts,branflakes,andgranola).
Fat.Goodfats,badfats,andtoomuchfat—howdowemakesenseofitall?
The most important fat fact is this: Your body’s actual fat requirement is
minuscule,asyousawearlier.MostpeopleinWesterncountriesgetmanytimes
theneededamount.Withmeatsanddairyproductsfrontandcenterintheirdiets,
theynotonlygettoomuchfatoverall,theyalsogetthewrongkind—saturated
fat,whichboostscholesterolandaggravatesinsulinresistance.
Nuts,seeds,avocados,olives,andfull-fatsoyproductsarealsohighinfat.
Although they are low in saturated fat, the overall amount is high, and you
shouldlimitthesefoodsaccordingly.
Asyoualsosawearlier,mostvegetables,fruits,andbeanscontainverylittle
fat,andwhattheydohaveisahealthfulmixture,includingtracesoftheessential
fatsalpha-linolenicacidandlinoleicacid.
If, for any medical reason, you are increasing your oil intake, healthful
sources of omega-3 fats include walnuts, soy products, flaxseed, and, in
concentratedform,flax,linseed,canola,andwalnutoils.Healthfoodstoreseven
sell omega-3 supplements (e.g., DHA) drawn entirely from botanical sources.
Theyareabetterchoicethanfishoils.Omega-6oilsarealsosometimesusedfor
healthconditionssuchasarthritis,usuallyintheformofeveningprimroseoil,
borage oil, black currant oil, or hemp oil. They should be thought of as
medicinalsupplementsratherthanasfoods.
Inthenextchapter,youwillgetstartedwithyournewprogram,andthen,in
Chapter7,Iwillshowyouhowtotrackyourprogress.
*
Theglycemicindexofafoodisdeterminedbyfeedingaportioncontaining50gramsofcarbohydrateto
10healthypeopleafteranovernightfast.Bloodglucoseistestedat15-to30-minuteintervalsoverthenext
2hours,andtheresultiscomparedtofeedingthesameamountofglucose(or,insomecases,whitebread).
AGIbelow100meansthefoodhaslesseffectonbloodsugar,comparedtoglucose.Ahighernumber
meansthetestfoodhasagreatereffect.
22
CHAPTER5
HowtoGetStarted
Bynow,youunderstandtheprinciplesforbuildingahealthfuldietandareready
togetstartedwithfoodsthatwilltameyourbloodsugar,helpyouloseweight,
andgoalongwaytowardloweringyourbloodpressureandcholesterol.Butyou
arenodoubtasking,howdoIstart?Andwillitbeeasy?WillIbeabletostick
withit?
Let me put your mind at ease. The two-step system described in the last
chapter makes this very easy. You just take a week to “check out the
possibilities”andthendoa3-week“testdrive.”Let’srevisitthisinmoredetail:
STEP1:CHECKOUTTHEPOSSIBILITIES
Take aweek,and seewhichhealthy foodsyoulike best.Youare notgoing to
eliminate anything. Rather, you’ll try out new products, new recipes, and new
tastes, and perhaps get reacquainted with a few healthy tastes you may have
forgotten.
Takeoutasheetofpaperandjotdowntheheadings“Breakfast,”“Lunch,”
“Dinner,”and“Snacks.”overthenext7days,writedown—ineachofthefour
categories—foodsyoulikethatmeetthethreeguidelinessetoutintheprevious
chapter.Inanutshell,wearechoosingfoodsthatare:
Vegan. They contain no animal products. This means no meat, fish, dairy
products, or eggs—not even a little bit. The idea is to clean the animal fat,
animalprotein,and cholesteroloutof yourdiet.Ifyouskipped tothis chapter
andarewondering whythesestepsare important,pleasegoback andreadthe
precedingchapter.
Lowfat.Youwilluselittleornoaddedoilandomitotherfattyingredients.
If you are reading labels, choose foods with no more than 3 grams of fat per
serving.
Low glycemic index. You will favor low-GI foods. This means generally
avoidingsugar,whitebreadproducts,bakingpotatoes,mostcoldcereals,anda
few other foods. Most other vegan foods are fine. Certain foods have an
especiallylowGIvalue:beansandotherlegumes,greenleafyvegetables,most
fruits,barley(whichisgreatinsoups),andthemanyfoodsthataremadefrom
them.Surprisingly,pastahasalowglycemicindex,unlikeotherwheatproducts.
HealthfulBreakfastIdeas
Under“Breakfast,”yourlistmaywellbesimilartowhatyouareeatingalready.
Hereareafewsuggestions.
Hot cereals such as oatmeal or other whole grain cereal with cinnamon,
raisins,and/orapplesauce(nomilk)
Coldcerealssuchasbranflakeswithfat-freesoyorricemilkand/orberries,
peaches,orbananas
Melon,cantaloupe,bananas,oranyotherfruit
Ryeorpumpernickeltoasttoppedwithcinnamon(nobutterormargarine)
Ifyoulikeextraprotein,trythese.
Veggiesausage
Veggiebacon
Scrambledtofu
Breakfastburritosfilledwith“refried”beans,lettuce,andtomato(noeggor
cheese)
Englishbakedbeansorchickpeas
Pumpernickelbreadwithhummus
Hereareafewthoughtsaboutsomegoodbreakfastchoices.
Oatmeal. Most of our research participants make old-fashioned oatmeal a
partoftheirmorningroutine,andforgoodreason.Oatsarerichinsolublefiber
—thekindthatgetscreamyinwaterand removescholesterol fromyour body.
(Wheatand rice arehigh ininsoluble fiber.) Butthat humble bowl ofoatmeal
doesmorethanthat.Ithelpsbringyourbloodsugarundercontrol,anditshigh
fibercontenthelpsyouloseweight.
Anadditionaladvantagecomesfromwhatoatsdonothave:cholesteroland
animalfat.Abacon-and-eggsbreakfasthasastrikinglylargeamountofboth.
Generallyspeaking,old-fashionedoatmealisbetterthaninstantor1-minute
varieties,althougheven thesequick-cookingversions arefarbetter thanbacon
andeggs.Themoreintactthegrain,thelowertheGI,andthelongerthecereal
keepsyousatisfied.SeeOld-fashionedoatmeal”fortipsonmakingtheperfect
bowlofhotoatmeal.
Foranextrabloodsugar–loweringeffect,topyourbowlwithcinnamon(see
WhichSupplementsShouldYouTake?”fordetailsabouthowcinnamonaffects
bloodsugar).Oraddraisins,berries,orjustaboutanyfruitormixoffruitsyou
like,butsetthemilkandsugaraside.Withinjustadayortwo,youwillbreakthe
habitof addingthese unnecessaryand unhealthfultoppings. Ifyou justcannot
imagineoatmealwithoutmilk, splashonsomesoymilkorrice milk;you will
skiptheanimalfatandcholesterolofcow’smilk.
MostdrycerealshaveahighGI,butoatmealisinagoodGIrange,asisbran
cereal. They will keep you full and satisfied and help keep your blood sugar
steady.
Veggie sausage or bacon. Regular sausage and bacon are loaded with
cholesterol and fat and are among the most unhealthful foods on anyone’s
grocerylist.Butifyouareunabletoimaginebreakfastwithoutthesemeats,food
manufacturers have come to your rescue with vegan versions, and most
supermarketsandallhealthfoodstoresnowcarryseveralvarieties. Iftheyare
newtoyou,thinkofthemasaliberalinterpretationoftheoriginal;theyaretasty
andhighinprotein.Readthepackagelabels,andchoosethosethatomitanimal
ingredients(somearemadewitheggwhite,whichisconcentratedanimalprotein
thatyouwanttoavoid)andareaslowinfataspossible.
Scrambledtofu.Tofuisalmostidenticaltoeggwhite—ithaslittleflavorof
itsownbutquicklytakesontheflavorsofwhateverspicesorsaucesitiscooked
with.Scrambledtofuisagreatsubstituteforscrambledeggs—ithasallthetaste
but no cholesterol, animal fat, or animal protein. Supermarkets sell scrambled
tofu seasoning mixes, usually shelved near boxed rices or in the health food
section.Justfollowthepackagedirections.
Breakfastburritos.Notimeforbreakfast?Breakfastburritostotherescue.
Youbuythemfrozen,poptheminthemicrowave,andinacoupleofminutes,
youhaveahearty,healthybreakfast.Healthfoodstoresandmostregulargrocery
stores stock a variety of frozen burritos made with beans, tofu, tomatoes, and
other ingredients. You can also make your own, of course, perhaps on the
weekend, and refrigerate or freeze them so they are handy for those busy
mornings.
Bagels. If bagels are your thing, favor pumpernickel bagels, which have a
lowerGIthanwhitebagels.
AFewThingsNotontheBreakfastMenu
Just to state the obvious, eggs are off the list. A single egg has around 200
milligramsofcholesterol—similartoan8-ouncesteak—plusaloadofsaturated
fat,thekindthattendstoraisecholesterol.Thewhiteoftheeggpresentsabig
doseofanimalproteinthatyouwanttoavoid.Asyouknow,gettingyourprotein
from plant sources is better for your kidneys and your long-term bone health.
SkipeggsandeggreplacementssuchasEggBeaters,whicharemadefromegg
whites.
Ofcourse,breakfastmeatsareoffthelist,too,includingturkeysausageas
wellasporkorbeefvarieties.Theyallhavecholesterolandanimalprotein.
Forgetdoughnuts,Danishes, andmuffins.Toseewhy,set oneona napkin
forafewminutes,thenlookathowmuchgreasehasleachedout.Thatgreaseis
just waiting to fatten you up, boost your cholesterol, and worsen your insulin
resistance.
ABalancedBreakfast
You may wish to start your breakfast with a high-protein food such as veggie
sausage and follow it with a starchier food like oatmeal with cinnamon and
raisinsorasweetfoodsuchasfruit.It’snotthatyouneedextraprotein;thereis
actuallyplentyofproteininanytypicalmealbuiltfromvegetables,grains,and
beans.Here’swhystartingwithahigh-proteinfoodcanbehelpful.
Starchyorsugaryfoodsnaturallyincreasetheproductionofserotonin—the
same feel-good chemical that is boosted by antidepressants such as fluoxetine
(Prozac)andsertraline(Zoloft)—inthebrain.Now,that’sanicebenefit,butfor
somepeople,theresultispostbreakfastdrowsiness.Infact,somepeopleactually
use starchy foods as a remedy for insomnia. A high-protein food blocks the
serotonin-producing action, boosting your energy. Any high-protein food will
do:veggiesausage,veggiebacon,scrambledtofu,beans,orevenaspoonfulor
twoofchickpeas—thekindyou’dnormallythrowonasalad.
So,duringthisfirstweek,explorethevariousbreakfastpossibilitiesandjot
downyourfavorites.
Sample1-DayMenu
Breakfast
Veggiesausage
Ryetoast
Oatmealwithcinnamonandraisins
Slicedcantaloupe
Lunch
Greensalad
Splitpeasoup
Hummussandwichonryebreadwithslicedtomatoandcucumber
Dinner
Spinachsaladwithcherrytomatoes
Angelhairpastawithtomatoandmushroomsauce
Steamedbroccoli
Snacks
Apples,oranges,bananas
HealthfulLunchIdeas
Okay,let’smoveontolunch.Hereareafewideas,butyouwillnodoubthave
manymore.
Salads
Gardensaladwithfat-freedressing,lemonjuice,orsoyorteriyakisauce
Three-beansalad
Pastasalad
Blackbeanandcornsalad
Grain-basedsalad,suchasnoodles,couscous,bulgur,orrice
Soups
Minestrone
Mixedvegetable
Lentil
Mushroombarley
Blackbean
Vegetarianchili
Splitpea
Instantandpreparedsoupsareokayaslongastheyarelow-fatandfreeof
animalproducts.
Sandwiches/Wraps
CLT: sliced cucumber, lettuce, and sliced tomato on rye bread with Dijon
mustard.Oruseveggiebacon,ratherthancucumber,ifyoulike.
Hummus on a whole wheat pita with grated carrots, sprouts, and sliced
cucumber
Sandwich made with fat-free meat alternatives such as veggie turkey,
bologna, or pepperoni slices or barbecued seitan (wheat gluten), plus your
favoritesandwichveggiesonryebread
Black bean dip, bell pepper and tomato slices, and lettuce wrapped in a
wholewheattortilla
Italianeggplantsub:bakedeggplantslices,pizzasauce,andmushroomsona
wholegrainsubroll
Blackbeanandsweetpotatoburritowithcornandtomatoes
Extras
Freshfruit
Chickpeas
Cut-upvegetables
Hereareafewmoredetailsongoodlunchchoices.
Salads. Salads vary from the simple lettuce-and-tomato variety to pasta
salads,three-beansalads,Asiansalads,fruitsalads,andmanyothers.
If you start with salad greens, regular lettuce is fine, but do not shy away
frombabyspinach,arugula,andothergreens.Addcucumber,artichokehearts,
andtomatoslicesandbyallmeans,chickpeas,kidneybeans,orotherlegumesto
yoursalad.Theyprovideplentyofnutritionandaregreatatholdingyourblood
sugarsteady.
For convenience, supermarkets carry commercial three-bean and four-bean
saladsinjars,whicharereadywhenyouare.Manystoresalsohavewell-stocked
saladbars.
Whenyouchoosedressings,lookforfat-freeveganvarieties,whichareeasy
tofindatmanysupermarkets.
Soups.Soupisagreatlunchstarter,orabigbowlofheartysoupcanbeyour
lunch. Loaded with vegetables, beans, lentils, barley or other grains, and
wonderful flavors,soups are satisfying andwonderfully healthful.Ifyou cook
upabigpotontheweekend,youwillbereadyfortheweekahead.
If you are looking for convenience, Manischewitz brand dried soup mixes
aretime-savers.Justaddthemtoboilingwaterandletthemsimmer.Ifyoulike,
addtomatoes,greenchiles,oranyfrozenorfreshvegetables.Stiratablespoon
ortwoof nutritionalyeast intoeachbowlfor asavorytouch.Ifyou addextra
carrots, tomatoes, frozen vegetables (e.g., broccoli, kale, cauliflower, or green
beans),andspices,youwillturnyoursoupintoastew.
If you’dliketo let someone elsedo the cooking, your supermarkethas an
endless varietyof cannedandfrozen soups. You need tobe selective, butyou
willfind plentythat meetour requirements.Lentil, minestrone,and vegetarian
vegetablearegoodchoices.Tabatchnickfrozensoupsoffergenerousservingsof
split pea, mushroom barley, and other flavors with simple ingredients and
virtuallynofat.
Instantsoupcomesinacupandjustneedshotwater.Youmightkeepafew
cupsinyourdeskdrawerforemergencies.
To have homemade soup anywhere, pick up an insulated bottle, such as a
Thermos,soyoucanjustfillitwithsoupandtakeittowork.Yourco-workers
willwishtheyhaddonethesame.
Onecaveataboutpreparedsoups:Somemanufacturersoverdoitwithsalt,so
it pays to choose lower-sodium brands. Aim to keep your total daily sodium
intaketolessthan1,500milligrams.
Sandwiches. Sandwiches are quick and portable, and with the enormous
varietyofingredientsavailablethesedays,theycanbehealthful,too.
Startwithalower-GIbread,suchasryeorpumpernickel.Tryanyorallof
thefollowingfillings.
Hummus is a Middle Eastern dish that has become popular in North
America. It is made from chickpeas and spices and has a texture vaguely
reminiscent of peanut butter but a milder flavor. Unfortunately, many
commercial brands are too high in fat, but who needs them? With a food
processor,ittakesonlyabout5minutestomakeyourown,andabigbatchwill
lastfordays.
Meatlessdelisliceshaveallthetasteofbologna,slicedturkey,orhamwith
noneoftheanimalfatorcholesterol.Theyaresoldatallhealthfoodstoresand
manysupermarkets,andtheymakegreatsandwiches.Youcanfindthemnextto
thevegetarianhotdogs,whicharealsogreatchoices.Asalways,chooselower-
fatbrands.
Veggieburgersareeasytomake,andcommercialbrandsarewidelysoldin
storesandrestaurants.Tryafewdifferentbrands,andfindyourfavorites.Favor
thosethatarelowestinfat.
A BLT made with veggie bacon, lettuce, tomato, and mustard is a great
choice.My own keep-it-simplesandwich isa CLT, madeon toasted ryebread
withlettuce,slicedcucumberandtomato,sometimesavegandelisliceortwo,
andtoppedwithDijonmustard.
Speakingofcondiments,mustardisfat-free;makeityourspreadofchoice.
Mostmayonnaisespreadsarejusttheopposite—theyareloadedwithfat.There
arenowmanyveganmayosonthemarket,buttheyarenotnecessarilylowin
fat.Checkthelabels.
Frozenmeals.TheTVdinnerhasgrownup.Theamazingvarietyoffrozen
foods,plustheconvenienceofmicrowaveovens,makesiteasytoeathealthful,
tastyfoods.Somefavoritesincludeveganenchiladaorburritodinnersandpizza
orpastadishes.
Iflunchmeansdiningout—orperhapsfastfood—seeChapter8forhealthful
restaurantchoices.
HealthfulDinnerIdeas
Thereisalimitlessarrayofhealthfulfoodsfordinner,whetheryouliketocook
ornot.Manypeopleenjoycooking,butmanyothersfeeltoobusyorjustcannot
be bothered; they tend to choose simple and convenient foods or eat out.
Personally,Ifallsquarelyintothesecondgroup.
Thegoodnewsisthatbothtemperamentsdoverywellinthisprogram.Here
areafewideasforstarters.
Pastamarinara:Manycommercialsaucesarefine.Choosethoselowestinfat
and free of cheese and other animal products. Add some mushrooms,
artichokehearts,orbroccolior spinach(prepared freshor frozen),and you
willbeset.
Beansandrice:TryCubanblackbeanswithsalsa,vegetarianbakedbeans,or
“refried”beans.
Softtacos:Startwithawholewheattortillaandaddbeans,lettuce,tomato,
andsalsa.
Chili:Vegetarianboxedversionsarefine.
Veggie lasagna: Use low-fat tofu to replace the ricotta, and add layers of
grilledveggies.
Ricepilaf,Spanishrice,orpackagedricedinners:Manycommercialbrands
arefine,butomitthebutter.
Friedriceandvegetables:Useanonstickpanandseasonthismealwithlow-
sodiumsoysauce.
Fat-freeveggieburgers:Readthelabelsandchoosethoselowestinfatand
freeofcheeseandotheranimalproducts.
Fajitas:Lightlysautéslicedbellpeppers,onion,andeggplantinanonstick
panandaddfajitaseasonings.
Stewmadewithchunkyvegetablesinasavorysauce
Mushroomstroganoff
Ourjobfornowisnottomakeyouintoachef,butsimplytomakearealistic
1-daymenuoffoodsyoureallywilleatandenjoy.
Itpaystothink“international.”manycuisinesfrom aroundtheworldhave
greatchoices,whetheryoumakethemyourself,havethematrestaurants,orbuy
them frozen: Mexican bean burritos, Italian pastas and bean soups, Chinese
vegetableandricedishes,Japanesevegetablesushiwithmisosoupandsalads,
Indiancurries,Thaidishes,Ethiopiancuisine,andmanyothers.Thesefoodstake
advantageoftherichtraditionofplant-baseddietsinmanycountries.
Ifyourideaofdinnerissendingoutforpizza,itcanstillbeveganandlowin
fat. Just ask for all-vegetable toppings, such as mushrooms, peppers, onions,
sun-driedtomatoes,andcapers.Holdthecheeseandaskforextratomatosauce
instead.Ifyouaremakingpizzaathome,youcanaddveggiepepperoniorother
delislicesifyoulike.Foracheesytaste,sprinkleonsomenutritionalyeast.
ABalancedDinner
Agoodwaytomakesureyourdinneriswellbalancedistofillaboutaquarterofyourplatewith
alegumedish.Thatmeansbeans,peas,orlentils.Soyoumightchoosebakedbeans,abean
burrito, or black-eyed peas, for example. These foods are rich in protein, soluble fiber, and
mineralsandhavewonderfullylowGIs.
Next, fill another quarter of your plate with a starchy food such as brown rice, a yam, or
pasta.Starchisanunglamorousword,butitreallymeanscomplexcarbohydrate—thehealthy,
clean-burningfuelthatpowersyourbody.
Finally, fill the remaining half of your plate with vegetables. Ideally, choose two different
varieties—say, a green vegetable like broccoli and an orange vegetable like carrots. These
foodsareyournutritionpowerhouses.Addfruitfordessert,andyouwillbeset.
Youcanvarytheseproportionsifyoulike.Aslongasyourplateisvegan,lowfat,andlow
GI,youwillbefine.
There are a million ways to do this. Some people like an Italian or Mediterranean meal,
whichmightincludebeansoupandpastawithachunkyvegetablesauce.OtherspreferLatin
Americanmeals,withbeans,rice,andvegetables.SomemightfavoranAsiandinner,withtofu
(whichcountsasalegumebecauseitismadefromsoybeans),rice,andvegetables.AnIndian-
inspiredplatemightincludealentilcurrywithriceandvegetables.
ForAmericansfromSouthernstates,manytraditionalfoodsfitthebillbeautifully:beansor
black-eyedpeas,rice,andgreens(withoutthetraditionalfatback).
WhenmyNorthDakotaparentsdecidedtoimprovetheirownwayofeating,wesubstituted
abeandishandvegetablecutletsfortheusualmeatdishandaddedyamsorsweetpotatoes,
alongwithacoupleofvegetablechoices.Dessertwaspears,strawberries,ororanges.Seethe
pattern?It’sstillthere:abeandish,astarchyfoodforhealthycarbs,vegetables,andfruitfor
dessert.
SimpleSnackIdeas
okay,yourday’smenuisnearlycomplete.Butevenifyoufeelyouwillnotbe
hungrybetweenmeals,pencilinafewsnackideassoyouwillbereadyincase
themunchiesdohit.A3:00p.m.Hungerpangcanerodeyourresolve,sostock
up on things that you can feel good about eating. Here are some snack
suggestions.
FruitshaveasurprisinglylowGIinmostcases,andtheyareunbeatablefor
nutritionalvalue.Keepapples,oranges,pears,bananas,andotherfruitsonhand.
Some people like to keep a bowl of cantaloupe and melon chunks in the
refrigeratorforaninstantsnackthat’s readywhen theygethome.Don’tforget
tropical favorites, like mangoes and papayas. Dried fruits are acceptable.
Surprisingly, their GIs are not necessarily higher than those of fresh fruit.
Becausetheir waterhas beenremoved, however, itis easyto takein farmore
calories with dried fruit than with fresh fruit, so it pays to favor the fresh
varieties.
Instantsoupsaregreattokeepinyourdeskdrawer;justaddhotwaterwhen
youarereadytoeat.Minestrone,splitpea,lentil,andothervarietiesaretypically
veganandlowinfat.
A simple CLT—the sandwich of lettuce and sliced cucumber and tomato
withmustardonryebreadImentionedabove—willfillyouup,withnothingto
regret.
Three-beansaladwillholdyouuntildinner.
Air-poppedpopcornskipsthefatoftheusualkind.Topitwithgarlicsalt,
mixedseasonings(e.g.,Spike),ornutritionalyeast.
Hummus on a whole wheat pita is filling and low in fat if you make it
withoutaddedoil.
Othersimplesnacksincludebrancerealwithsoymilk,pumpernickelorrye
toast with jam, carrot sticks, and rice cakes (look for simple, unsugared
varieties).
STEP2:A3-WEEKTESTDRIVE
Allright,youaredoinggreat!Youhavemadegoodchoicesthatwillgiveyoua
healthystart.Now,let’stakea3-weekperiodand,duringthattime,let’smakeit
allveganallthetime.Thatmeansnoanimalproductsatall,keeptheoilslow,
and favor healthy, low-GI foods. At this point, that will be easy, because you
pickedoutthefoodsyoulikeduringweekone.Noneedtowhipupsomething
neweveryday.Itisfinetorepeatitems,useleftovers,ormakeyourlifeeasyin
anywayyoucan.Remember,though,donotlimitcaloriesorskipmeals.
Itisessentialtoberealistic.Ifyoudonotenjoycookingnow,thatisunlikely
tochange.Plantohavefoodsonhandthatrequirelittlepreparation.
Will you be at work? Traveling? Planning ahead is essential. If there is
nothing healthful in the company canteen, you will want to pack a lunch.
Sometimes when a colleague asks what I am having for lunch, I answer, les
restes d’hier.” This sounds exotic until I explain that the phrase is actually
French for “leftovers.” But the fact is, my leftovers sometimes are exotic,
dependingonwhichrestaurantfilledthedoggiebag!
Let’sGoShopping
It pays to stock your shelves with the foods and ingredients you will need so
your3-weektestdrivegoessmoothly.Andwhenhungerhits,youwillbeready.
Take a trip down those aisles at the supermarket that you may well have
neglectedinthepast.The producedepartmentmaystockmeatsubstitutes,soy
milk,andotherhealthyproducts,alongwithanever-growingarrayofnewand
interesting fruits and vegetables. Also check out the “international,” “health,”
and“dietetic”aisles.Andlookattheshelveswithinnumerablevarietiesofrice
andcolorfuldriedbeans.
Besuretocheckoutyournearesthealthfoodstoreifyouhavenotdoneso
already.Youwillfindsubstitutesformeatandmilkandinterestingfoodsfrom
other countries, all worth a try. Explore and experiment; some new finds will
becomefavorites.Iftheoccasionalpurchaseturnsouttobeadud,donotworry.
Thatiswhatexperimentingisallabout.
Asyoushop,pickupingredientsthatwillallowyoutoprepareafewextra
thingsontheweekend—apotofsouporstew,forexample—thatyoucanthen
splitintoportionsforquickreheatingduringtheweek.
You will notice that prices for healthful foods vary widely. Overall, plant-
basedfoodsarelessexpensivethanmeatyorcheesyproducts.Beans,freshand
frozen vegetables, pasta, rice—these humble ingredients cost very little.
However, health food stores sometimes put premium prices on prepared
products,whichistruefornonvegetarianaswellashealthfulveganitems.You
willsoonsortoutyourbestchoices.
Whileyouareatthestore,pickupavitaminB
12
supplement,andifyoudo
notgetregularsunshine,purchaseavitaminDsupplement,too.
SomeStaples:BasicFoodstoTasteandTry
Thereareafewbasicfoodsthatwouldbegoodforyoutogettoknow.Theyare
notelaborate—justsimple,basicstaplesthatoughttobeonyourshelves.Ifthey
arenew toyou, theywill behealthful additionsto yourrepertoire. Letme list
somehereandencourageyoutothinkaboutthemwhenshopping.
Old-fashionedoatmeal.Choosethisvarietyratherthaninstant,andseehow
easyandfastitistomake.Justcombine1partoatmealwith2partscoldwater,
bringtoaboil,andsimmerforafewminutes.That’sallthereistoit.Oatmealis
loadedwith solublefiber tobringyour cholesteroldown andfillingenough to
keep hunger at bay all morning. While you are at the store, pick up some
toppings:cinnamon,raisinsorotherfruit,orwhatevercallstoyou.
Beans.Gettoknowthemanyvarietiesofthishumblefood.Verylowinfat;
devoid of cholesterol; high in soluble fiber, calcium, and iron; and with an
enviableglycemicindex,beans’dayhasarrived.Cookthemupfromscratchif
you like, but it’s handy to stock your shelves with a couple of cans of black
beans(and ajarofsalsa),fat-free “refried”beans,and anyother varietiesyou
see.
Frozenvegetables.Convenienceisthewordhere.Ifyouaretheslightestbit
pressedfortime,youwillbegladyouhavevegetablesinyourfreezerthatjust
need a little steaming. Nutritionally, frozen vegetables are equivalent to fresh.
Look for broccoli, winter squash, petite Brussels sprouts, carrots, cauliflower,
andanythingelseyoufancy.
Lentilsoup.Lentilsassertthemselvesinaheartyandhealthfulsoup.Keepa
canortwoonhand.
Hummus. As I mentioned above, thissimple chickpea dip has become an
enormouslypopularsandwichfilling.Butskipthecommercialbrands,whichare
toohighinfat.Ifyouhaveafoodprocessor,youcanmakeyourowninlessthan
5minutes,andyouwillbesetfortheweek.
Chickpeas.Speakingofchickpeas,thisisonelegumethatisreallyathome
justaboutanywhere—notjustashummusbutalsoinsalads,soups,pastasauces,
and stir-fries. You can even eat them for breakfast. Keep a few cans on your
shelf;theextra-smallcanswithpop-toplidsareespeciallyconvenient.
Toppings.Dijonmustardisgreatforsandwiches,andlemonjuiceorapple
cidervinegaris greaton green vegetablesand salads. Salsawas just madefor
beans,andfat-freedressingsofanyvarietyarehandy,too.
Brownrice.Mostpeoplehavenevertastedaproperlypreparedbowlofrice.
The trickis to selectbrown rice, toastit slightly, and cook itlike pasta, using
whatmayseemliketoomuchwateranddrainingawaytheexcessattheend.
Barley.Thisgrainisalloverthebreakfastcerealaisle,inpuffedandsugared
form,butbarleyreallyshinesinsoupsorwhenservedasagrainsidedish.You
canmixitwithriceandcookthemtogether.BarleyhasalowGI,lotsofsoluble
fiber,andwonderfultasteandtexture.
Spaghettisauce.Takeafewminutestoreadlabelsonjarsofmarinarasauce
tofindvarietiesthatexcludecheeseandotheranimalproductsandkeepoiltoa
minimum. Then stock your shelves for a quick and easy dinner. Pick up your
favoritepastatogowithit.
Meat substitutes. Try the veggie versions of hot dogs, burgers, and deli
slices. They are not haute cuisine, but they serve a useful purpose, and some
tastesurprisinglysimilartothefoodstheyimitate.Readthelabels,though,and
skipproductswithanimal-derivedingredientsormorethan2to3gramsoffat
per serving. Health food stores have a huge selection, and many regular
supermarketscarrythem,too.
Nutritionalyeast. You canfindthis inthesupplement aisleathealthfood
stores. Nutritional yeast dissolves into spaghetti sauces, stir-fries, casseroles,
soups, andlots of other recipes,adding a subtle cheese-liketaste. It isnot the
sameas brewers yeastor bakersyeast, both ofwhich taste bitter. Nutritional
yeast comes in flakes and powder. For better texture and versatility, buy the
flakes.
Freshfruit.Freshfruitis aperfectsnack,and youwillwantto keepiton
hand.Buyextraforfriendsandfamily.
ChecktheLabel
Therearetwothingsyouwanttolookforonproductlabels.First,checktheingredientslistto
makesure there are no animal-derived ingredients. Common ones includemilk solids, whey,
casein(andvariouscaseinderivatives,suchassodiumcaseinate),eggproducts,andgelatin.
Alsobeonthelookoutforpartiallyhydrogenatedvegetableoils,whichareasbadassaturated
fat.
Sometimespeople want tomake exceptions forfoods that soundas if they are healthful.
Honey,forexample,hasgottenunjustifiedgoodpressoverthedecades.Nutritionallyspeaking,
it is simply sugar, offering you nothing from a health standpoint. Rather like olive oil, its
marketinghasgottenwayaheadofitsvalue.
Next,check the NutritionFacts.Ideally, a servingof food will haveno more thanabout 3
gramsoffatandshouldhavezerocholesterol.Ifthecholesterolcontentisanythingotherthan
zero, the product contains some animal-derived ingredient. If label reading seems a bit
cumbersome, keep in mind that you need to check a product only once. As you find the
productsthatfitthebill,there’snoneedtocheckthemagain.Also,simplefoodsdonotneed
labels.Nooneeverhadtolookforthefineprintonabananaorpear,aboxoffrozenspinach,
orabagofnavybeans.Eachofthesefoodshasexactlyoneingredient.
WhattoDowithUnhealthyFoods?
So you have filled your shelves and refrigerator with healthy staples. If some
not-so-healthfulitemsfromyourpreviousdietarestilllurking,though,whatdo
youdo? That’s easy:getridofthem. Donot“use themup”because theywill
continue to cause problems for you. Toss them. And if family members or
roommates share your kitchen space, avoid keeping tempting foods too near
yourown.Theywillpresentmoreofatemptationthanyouneed.
PlanningAhead
Eventually, healthful eating will become second nature. For now, though, you
will need to put a bit of thought into where you will be at lunchtime and
dinnertimeandwhat youwillhave.Therereally arehealthychoicesoutthere,
buttheyaresometimesnotsoobviousinaculturethatcaterstounhealthytastes.
Ithelpstoplanahead.
ONYOURMARK,GETSET…
Aswe’vediscussed,youwillwanttopickouta3-weekperiodandreallydive
intothisnewmenu.Chooseatimewhenyouhavethementalenergytoembrace
achange.Ifyouareanaccountant,April14probablyisnotagoodtime.Ifyou
areastudent,examweekmaynotbethebestchoice.Butonceyouhavepicked
yourtime,jumpinwithbothfeet.Dothedietchange100percent.Followour
threeguidelinesascloselyashumanlypossible,anddoitalltheway.
Okay, you havedonegreat. You havethe basics down.In the nextseveral
chapters,wewilllookatspecifichealthissuesandsituationsyoumayencounter,
andIwillofferplentyoftipsforhandlingthem.
CHAPTER6
HealthfulWeightControl
Ifyouhavebeenaimingtoloseweight,letmeshowyouthestepsthatmakethe
process as easy, effective, and permanent as possible. Eliminating unwanted
pounds is important for anyone—but especially for people with diabetes. For
starters,itboostsyourinsulinsensitivity;themorebodyfatyoutrimaway,the
moreresponsiveyourcellsaretowhateverinsulinyourpancreasisproducing.
Weightlossalsobringsdownyourcholesterolandbloodpressure.Andwhen
you’vetrimmedawaybodyfat,exerciseisthatmucheasierandmoreinviting.
Yourjoints—especiallyyourknees—willthankyou.
Needlesstosay,thereareagreatmanywaystoloseweight.Cuttingcalories
worksforsome people,butothersfind itarealchallenge.Ifyou normallyeat
2,000caloriesperday,forexample,acommonrecommendationwouldlimityou
to1,500—andthatgetsoldveryfast.Ifyou’rehungryat8:00intheeveningand
you’vealreadyhadyour1,500caloriesfortheday,youwillgotobedhungry.
Thatwillneverhappenontheprogramrecommendedinthisbook.
A healthy approach to weight loss focuses on choosing the right kinds of
foods,not onthe quantityof food you eat. Whenyou have the right foodson
yourside,thecaloriesandportionsfallintolineontheirown,andweightlossis
almostautomatic.
AWEIGHT-LOSSDIETTHATWORKS
In2005,myresearchteampublishedtheresultsofanimportantstudythattested
anewandpowerfulapproachtoweightloss.Theparticipantswerewomenwith
moderatetosevereweightproblems.Mosthadtriedmanydifferentdiets:low-
calorie diets, low-carbdiets, Weight Watchers, the cabbage-soup diet, andjust
about everything else. Like most people, they had found these diets tough to
follow,andwhateverweighttheylostsoonreturned.
Ourapproachwasvery different.Itdid notincludecaloriecounting,limits
on portions or carbohydrates, or even an exercise prescription. For research
purposes,wewantedtoisolatetheeffectsofdiet.
The participants lost weight easily, averaging about 1 pound per week—
weekafterweekafterweek—andtheykeptitofflong-term.
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Otherresearchers
havefoundmuchthesamething.
Whyisaplant-baseddietsopowerfulforweightcontrol?Well,firstofall,it
isimportanttounderstandwherethecaloriesarehidinginthefoodsyoueat.A
chickenstoresextracaloriesinchickenfat.Acowstorescaloriesinbeeffat.A
fish stores them in fish fat. Body fat—in humans or animals—is a calorie-
storagesystem.
Ifyouweretoremoveabitoffatfromadrumstickorchickenwingandsend
it to a laboratory, you would find that a gram of fat—that’s
1
28
ounce—has 9
calories. That is a lot. It is more than double the calories in a gram of
carbohydrate—the starch in rice, beans, or sweet potatoes, for example.
Carbohydrates have only 4 calories per gram. Small wonder that people who
makericeorotherplantfoodstheirstaplestendtostayslim.ThroughoutAsia
andruralAfrica,riceandothergrains,rootvegetables,andvariouslegumesare
thetraditionalfoundationofthediet.Thesefoodsarefillingbuthaverelatively
fewcalories.
Ofcourse,it’sadifferentstoryinNorthAmericaandEurope,wheremeals
feature meat and dairy products, which contain the very fat that animals have
used to store their excess calories. Weight problems are the all-too-common
result.Ifyouwanttoavoidtakinginextracalories,youwoulddowelltoavoid
eatingtheconcentratedcaloriesthatanimalshavehiddenawayintheirbodyfat.
So,steponeistoavoidanimalproducts.Ifyoudothat,youwillofcourse
avoidanimalfatcompletely.
Steptwoistokeepvegetableoilstoaminimum.Beans,grains,vegetables,
fruits, and most other foods from plants have very little fat. There are a few
exceptions,however:nuts,seeds,avocados,andsomesoyproductsarehighin
fat.Keepthemtoaminimumaswell.
Be especially careful about vegetable oils used in cooking or in salad
dressings.Now,somepeoplearguethatplantoilsaremorehealthfulthananimal
fats,andit’struethattheyaremuchlowerinsaturatedfat,thekindthatraises
cholesterollevelsandislinkedtobreastcancerandinsulinresistance.Whenit
comes to weight problems, however, animal fats and vegetable oils are
essentiallyallthesame.Theyallpackin9caloriespergram.
Step three is to focus on high-fiber foods. A grain of brown rice, for
example, hasa thin cloak of fiberthatgives the rice itstan color. To produce
whiterice,manufacturersstrip awaythiscoating,but youarebetteroffifitis
leftintact.Fiberfillsyouupsoyoufeelnaturallysatisfiedwithfewercalories.
AsyousawinChapter4,every14gramsoffiberaddedtoyourdailymenu
cuts calorie intake by about 10 percent on average.
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That simply means that
high-fiberfoodsfillyouupfaster,soyoustopeatingsooner.Insteadoftryingby
sheer force of willpower to cut calories, you cut them without even thinking
aboutit.
Therichestsourcesoffiber arebeans, vegetables,fruits, andwhole grains.
Whilebreakfastcerealcommercialstendtopushgrainsasthebestfibersource,
youwillfindmuchmorefiberinbeansandmostvegetablesthaninmostgrains.
Buttheyalladdup.Aimforatleast40gramsperday.Onecaveat:Ifhigh-fiber
foods, especially beans, have not been part of your routine, you’ll want to
increasetheamountyoueatgraduallytogiveyourdigestivetracttimetoadjust.
SeeChapter9formoretipsonavoidingdigestiveproblems.
Inthenextchapter,Iwillshowyouaneasywaytocheckyourfiberintake
usingtheQuickFiberCheck.
Okay,let’ssummarize:Toloseweight,youwanttoavoidanimalproducts,
limittheuseofvegetableoils,andgohighfiber.Vegetables,fruits,wholegrains,
andbeansfitthebillperfectly.
StepstoWeightLoss
1. Avoid animal products. If you steer clear of fish, chicken, beef, dairy foods, and all other
animalproducts,youwillcutyouranimalfatintaketozero.What’smore,thisshiftwillmean
thatyouwillnaturallyeathigh-fiberfoodstoreplacethosefromanimalsources,whichhave
nofiber.
2. Keepvegetableoilstoaminimum.Ifyouhaveabottleofcookingoilinyourkitchen,throwit
away.Therearesimplerandbetterwaystocook.Alsolimitnuts,seeds,avocados,andfull-
fatsoyproducts.
3. Favorhigh-fiberfoods.Buildyourmealsfrombeansandotherlegumes,vegetables,fruits,
andwholegrains.
Toensurecompletenutrition,besuretohaveavitaminB
12
supplementeachday.
HEALTHYEXAMPLES
By now, you already have a good idea of what this looks like on your plate,
becausethedietchangesforweightlossareverymuchlikethoseforcontrolling
yourbloodsugar.Breakfastmightstartwithveggiesausageorveggiebacon—
thatis,fauxmeatsmadeofsoyorwheat—followedbyabigbowlofoatmealor
perhaps some fresh fruit. You would skip bacon, eggs, and ordinary bagels,
whicharestrippedoffiber.
Lunchcouldbeasandwichmadewithslicedtomato,lettuce,andveggiedeli
slicesonrye,orapastasaladwouldbefine,too.
Fordinner,youmighttrytomatoorsplitpeasoupfollowedbyavegetable
stir-fryorshepherd’spiefilledwithchunkyvegetables.Intheprocess,youwill
avoid animal fat, have very little vegetable oil, and get all the fiber in those
healthyvegetables.
For a between-meal snack, an apple or banana fits the bill nicely, while
potatochipsornutspacktoomuchfat.
Vance
WhenVancejoinedourstudy,hewantedtogethisweightdownto210to225
pounds.Since heinitially weighedinat276pounds, hehad aways togo. He
stucktothedietprogram,however,notworryingaboutcaloriesorportionsbut
payingcloseattentiontothetypesoffoodhechose.Everythingwasveganand
lowinfat.Also,inordertogivethedietagoodtest,heagreednottoaddany
exerciseforthefirst6months.
Thepoundsstartedtocomeoff.Threemonthslater,heweighedinat251—a
lossof25poundsinabout12weeks.Friendscouldn’thelpbutnotice,andmany
askedhimwhathissecretwas.After6months,hewasdownto238.Atthe14-
monthmark,hewasat217.
Nancy
Nancybeganthestudyat197pounds.LikeVance,shechangedherdietbutkept
heractivitylevelthesametoallowustotestwhatthedietchangealonecould
do.Threemonthsintotheprogram,herweightwasdownby14pounds.After6
months,shehadlost25pounds,andat14months,sheweighed155pounds—a
lossof42poundswithoutcountingcalories.
NotExactlyHealthFood
Afewyearsago,Iwasrunningastudyondietandweightlossandfoundthatacoupleofour
participants were chowing down on Twizzlers—the red candy that comes in long twists like
licorice.WhenIasked why they were eatingcandy,theypointedout that the product is both
vegan and low in fat. And sure enough, there’s a friendly message printed on a package of
TwizzlersStrawberryTwists:
Didyouknow…
Strawberry Twists are a low-fat candy! That’s right, the same great-tasting
Twizzlersyouhaveknownandlovedarelowinfat,asalways.Nothinghaschanged.
Alookattheingredientslistshowsthat,indeed,nothinghaschanged.Likeothercandies,it
isbasicallyasugaryconcoctioncontainingnothingthatyourbodyevenremotelyneeds.Sugar
isnowherenearashighincaloriesasfat,butitstillprovidesmorecaloriesthanyouneed.
FOODSTHATWORKMAGIC
These simple foods have surprising effects. Not only do they help you trim
hundredsofcaloriesoffyourdailymenu,theyalsocauseafundamentalchange
withinthecellsofyourbody.AsyousawinChapter2,clinicaltestshaveshown
thattheyincreaseyourbody’safter-mealcalorieburn.Thereasonisthis:Asyou
change your diet, your insulin sensitivity begins to improve. That means that
glucosehasaneasiertimeenteringyourcellstobeburnedforenergy,ratherthan
continuingtocirculateinyourblood.
3
Theafter-mealcalorieburnissmall,butit
lasts for3 or more hours after eachmeal, giving you an extraedge for losing
weight.
APPETITECONTROL
BarbaraRolls,PhD,aresearcheratPennsylvaniaStateUniversity,hasproposed
aninnovativewayofthinkingaboutappetitecontrolbasedonaconceptcalled
energydensity.
4
Herstudieshave lookedat whattriggers satiety—thesense of
fullness after meals—and shown how to plan meals to bring on a feeling of
satietyearlier.
Surprisingly,whatmakesusstopeatingdoesnotseemtobethenumberof
calorieswehave ingested,nor isittheamount ofcarbohydrateorprotein ina
meal.Rather,itistheweightoffoodwehavetakenin.Itisasifyourstomach
hasa scale,and onceit registersa certainnumberof gramsof food,it signals
yourbrainthatyouhavehadenough.
Wealltendtoeatroughlythesameweightoffoodeachday.Ifyourmeals
donotaddupastheynormallydo,yourappetiteguidesyoutohavealittlemore.
There’saneffectiveweight-lossstrategyinthere.Ifthefoodsyoueatcontain
afairamountofwater—soupsorfruit,forexample—theyareheavyenoughto
tipyour“stomachscale”andreduceyourappetite.Becausetheweightofthese
foods comes mainly from water, which has no calories, they tend to cut your
totalcalorieintakefortheday.Thesefoodshavealowenergydensity.Thatis,
theyhaverelativelyfewcalories,eventhoughtheymighthaveenoughweightto
convinceyourstomachthatyou’veeatenquitealot.
Oneimportantcaveat:Forsomereason,simplydrinkingwaterwillnotturn
offyour appetite.Your stomachapparently reactsdifferentlyto heavyfoods—
whichtriggeranappetiteshutoff—thantoadrinkofwater,whichdoesnot.
Dr. Rolls proved this with an interesting lunchtime experiment. When
researchvolunteersateacasseroleappetizeralongwithaglassofwater,theyate
about400caloriesatlunch.Inaseparatetest,however,shestirredtheglassfulof
water into the casserole to make soup. When she measured the participants’
calorieintakeafterward,shefounditwascuttolessthan300.Thesouptricked
theirstomachsintoshuttingofftheirappetites.
Herearesometipsforreducingtheenergydensityofyourmeals.
Soupsareagreatchoice.Theyarefillingbutgenerallylowincalories.Favor
clear,low-sodiumsoupsratherthancreamyvarieties.
Addtomatoes,chickpeas,cucumbers,peppers,andothervegetablestoturna
salad into a meal while keeping it low in calories. Use fat-free dressing,
lemonjuice,orapplecidervinegarratherthanregularoilydressings.
Apples,oranges,pears,mangoes,papayas,berries,andmostotherfruitsare
excellentchoicesforsnacks,desserts,orameal.
Vegetables of virtually any variety are good choices. Adding chunky
vegetables to salads and casseroles reduces their energy density in a very
helpfulway.
Beandishesarefilling,butsurprisinglymodestincaloriesiftheyaremade
withoutaddedfat.Thinkofchiliandcasseroles.
Goforwholegrains.Ricebeatsricecakes.Pastabeatsbread.Ineachcase,
oneis water-based andfilling,while theotheris airyandnot fillingatall.
Old-fashionedoatmealisagreatbreakfastchoice.
Includingthesefoodsgenerouslyinyour menuwill accelerateyour weight
loss. There’s an easy way to check the energy density of commercial food
products: Just take a look at the label. If one serving has fewer calories than
grams, it is a good choice. For example, the label on a can of black beans
(below)showsthataservinghas90caloriesandweighs122grams,sothebeans
areagoodchoice.
BlackBeans
NutritionFacts
ServingSize½cup(122g)
ServingsPerContainerApprox3½
AmountPerServing:Calories90,CaloriesfromFat5
A can ofspinach has 30 calories and115 grams per serving, so it’s also a
winner.Eachofthesefoodshaslessthan1caloriepergram,sotheweightofthe
foodfillsyouupbeforethecaloriesfillyouout.
What about skinless chicken breast? One serving has 173 calories and
weighsabout100grams(3.5ounces).Notagoodchoice.Asidefromnotbeing
veganorparticularlylowinfat(23percentofcalories),ithasfarmorecalories
thangrams.
A slice of bread may have 80 calories and weigh 32 grams. It has few
calories but is very lightweight, so it is not filling. With more calories than
grams,itisnotespeciallyhelpfulforweightloss.
I am not suggesting that you use energy density in place of the other diet
guidelinesinthisbook.Useitinadditiontothisprogramtorampuptheweight-
loss power of your new menu. It will help you pick from among the allowed
foodsthosethatarethemostfillingwiththefewestcalories.
Again,theideaissimplytoreducetheenergydensityofthefoodsyoueatby
choosingthosethat naturallycontain afairamountof watertofillyou upand
shutoffyourappetite.
STEERCLEAROFLOW-CARBDIETS
Low-carbohydratedietsarepopular,onandoff.Buttheyarepotentialdisasters
for anyone, especially for people with diabetes. They often bring short-term
weight loss, but most of the weight quickly returns. Low-carb diets also have
wildlyunpredictablehealtheffects.Inresearchstudies,asmanyasone-thirdof
low-carbdietershaveshownasignificantincreaseinLDL(“bad”)cholesterol.
Somehavehadsuchhighcholesterollevelsthattheyhavebeenforcedtodrop
outofstudies.
What’smore,low-carbdietsareusuallyhighinprotein.Theanimalprotein
that is commonly emphasized in these diets can be hard on your kidneys.
Harvardresearcherstrackedkidneyfunctionin1,624womenparticipatinginthe
Nurses’HealthStudy,focusingespeciallyonthosewhohadanylossofkidney
functionatthestartofthestudy.Itturnedoutthatthemoreanimalproteinthe
women consumed, the more kidney function they lost.
8
Given that about 40
percentofpeoplewithdiabeteshavealreadylostsomekidneyfunction,itmakes
goodsensetoprotectyourselfagainstfurtherdamage.
9
Istronglycautionagainst
anydietsthatrecommendhigh-proteinfoods.
As you have seen, such diets arebased on the outdated idea that avoiding
carbohydratesisthekeytoglucosecontrol.Asyouknowbynow,populations
that make rice, noodles, and other carbohydrate-rich foods their diet staples
actuallyhavehadverylittleobesityandverylittlediabetes.
Sometimes,whenpeopleblame“carbs”fortheirweightproblems,theyare
thinking of cookies and cupcakes. But if you have ever looked at recipes for
theseproducts,youknowthatanenormousloadoffat—typicallyfrombutteror
shortening—is usually lurkinginside. So the carbohydrate in theseproductsis
reallyaninnocentbystander;it’stheirloadoffatthatcanfattenyouup.
Ifyouarestuckinthe“carbsarefattening”mentality,letmesharetheresults
of an important study. National Institutes of Health researchers asked 19
overweightvolunteerstofollowarigorouslycontrolledlow-carbdietandalow-
fat diet at separate times—all the while under the watchful eyes of the NIH
MetabolicClinicalResearchUnit,wheretheylivedthroughouttheexperiment.
Bothdietshadpreciselythesamenumberofcalories;thedifferencewassimply
thatonewaslowinfatandtheotherwaslow-carb.Buttheresultswereclear.
Thelow-fatdiettrimmedawayroughlytwiceasmuchbodyfat,comparedwith
thelow-carbdiet.
10
Low-carb diets can cause weight loss over the short run, but there are far
healthierways toachievethat goalandto makeweightloss lastover thelong
run.
Low-CarbDietsCanWorsenCholesterolLevels
Weight loss lowers cholesterol levels. On average, each pound you lose lowers your
cholesterollevelabout1point(thatis,1mg/dlor0.3mmol/l),
5
somostweight-lossdietshave
a side benefit of improving your cholesterol test results. The exception is low-carbohydrate
diets.Theyaresohighinfatandcholesterolthattheyincreasecholesterollevelsforaboutone
ineverythreedieters,someofwhomhaveeventuallyexperiencedwildlyhighcholesterollevels
and serious heart disease symptoms.
6,
7
There is no good reason to begin any low-
carbohydrate,high-proteindiet.
WHATTOEXPECT
Everyonelosesweightathisorherownpace.Inourstudiesusinglow-fatvegan
diets, weight loss averages about 1 pound per week. Adding exercise can
increaseyourweightlossdependingonyourregimen.
Youmayfindthatyouloseweight,thenreachaplateauandstaytherefora
while. If that happens, see if there is something in your diet you can change,
such as eliminating hidden sources of oil or boosting your fiber intake, or
bringinginthelow-energy-densityfoodswediscussedabove.Ourbodiesseem
tohavedifferentplateausdependingonthefatcontentofourfoods.Thatisto
say, if you drop the fat content slightly, your weight will probably drop a bit,
then plateau. If you drop the fat content more, you’ll drop down to a new
plateau.
Thesamethingworkswithfiber.DoaQuickFiberCheck,andifyou’renot
up to 40 grams per day, try adding more beans, vegetables, fruits, and whole
grainstoyourdiet.You’llfindthatthecombinationofsteeringclearoffatsand
bringinginfiberhelpstrimawaythepounds.
TakeYourTime
If you have gradually gained weight over the years, let it come off gradually.
Don’tstarveyourselfinthehopeofinstantresults.Ifyouareonanoptimaldiet
andare physicallyactive,nature willtakeits course.Asthe weeksgo by, you
willnotonlybeslimmer,youwillalsobehealthier.Yourcholesterolandblood
pressurearelikelytofallalongwithyourbloodglucose.Asalways,stayinclose
touchwithyour doctorsoyourmedicationdoses canberevisedas youregain
yourhealth.
CHAPTER7
HowtoTestYourselfandTrackYour
Progress
In this chapter, we will look at the various tests that allow you to track your
progress.Thefirstone,glucosetesting,isparticularlyimportant,butpleaseread
throughthewholechapter.Itwillhelpyoustayontherightpath.Wewillstart
withbloodtestsandthenlookatotherkindsoftesting,includingweight,blood
pressure,andexaminationsoftheeyesandfeet.
GLUCOSETESTING
Monitoring your blood sugar is important for controlling diabetes. Glucose is
measured in milligrams per deciliter (mg/dl) in the United States and in
millimolesperliter(mmol/l)inmostoftherestoftheworld.
If you have type 1 diabetes or are using insulin for type 2 or gestational
diabetes,youshouldcheckyourglucoseatleastthreetimesadayoraccording
towhateverscheduleyourdoctorrecommends.Ifyouhavetype2diabetesand
are using oral medications, there is no optimal testing frequency. As a rule of
thumb,however,whenyourdiet,medications,exerciseroutine,orhealthstatus
changes,itisimportanttotestmorefrequently.Ifyourdoctorisnotyetaware
thatyouareabouttomakeachange,nowisthetimetosharethatinformation.
Youshouldalsodiscusswhattodoifyourbloodglucoseistoohighortoolow.
Asyoubeginahealthfuldiet,yournumbersarelikelytofallsignificantly.
Regular glucose testing is especially important if you are taking diabetes
medications,particularlyinsulinormedicationsthatcauseyourbodytorelease
insulin.Thereasonisthatthesearepowerfuldrugsthatactivelypushyourblood
sugardown.Andyouarenowstartingapowerfulnewdiet.Thecombinationof
thesetreatments—drugsanddiet(sometimesalongwithexercise)—mayendup
pushingyourbloodsugartoolow.
I know what you may be thinking: Impossible! If all you have ever heard
from your doctor is that your blood sugar is too high, it’s hard to imagine it
could fall too low. Well, it can. The combination of a powerful diet and the
diabetes medications you may already be on can be very strong. In fact, your
bloodglucosecan fallso lowthatyoustart toshakeandsweat(seebelow for
othersymptoms).Thisiscalledhypoglycemia.Inrarecases,peoplewhomakea
majordietchangeorembraceastrenuousexerciseprogramwithoutbackingoff
onmedicationsfindtheirbloodsugardropsdangerouslylow—solowthatthey
can lose consciousness. This is why it is essential that your doctor be made
aware of the changes you are making—so your medication dosages can be
alteredifyourbloodglucosetakesanosedive.
Dangeroushypoglycemiaisveryunlikelyifyouareonnomedications,and
itisalsounlikelyifyouarebeingtreatedwithonlymetformin(Glucophage)ora
thiazolidinedione, such as pioglitazone (Actos) or rosiglitazone (Avandia).
However,hypoglycemiaislikelytooccurifyoutakeanyofthefollowingdrugs.
Insulin(injectedorpump)
Glyburide (Micronase, Glynase, DiaBeta, or the combination drug
Glucovance)
Glipizide(Glucotrol)
Glimepiride(Amaryl)
Nateglinide(Starlix)
Repaglinide(Prandin)
This is just a short list of medications that may put you at risk. Ask your
doctorifthemedicationsyouaretakingmaycausehypoglycemia.
Although hypoglycemia is a sign that your body is regaining its insulin
sensitivity—which is of course a good thing—it is also a sign that your
medicines are now too strongandthat you need to speak with your physician
rightawayaboutadjustingyourmedicationregimen.Ifyourdoctorhasstopped
yourmedications,hypoglycemiaisveryunlikelytooccur.
Symptomsofhypoglycemiainclude:
Shaking
Sweating
Hunger
Anxiety
Weakness
Rapidheartbeat
Dizzinessorlightheadedness
Sleepinessorconfusion
Difficultyspeaking
Ifyouexperiencethesesymptoms,checkyourbloodsugar.Ifitisbelow70
mg/dl (3.9 mmol/l) or whatever other benchmark value your doctor
recommends,youneedtoeatsomethingthatraisesyourbloodsugarquickly.If
you notice symptoms while driving, pull over to a safe spot. And if you are
unabletotestyourbloodsugarorareunsurewhetheritislow,assumethatitis
lowandhavesomethingtoeat.Glucosetabletsareagreatchoice.Theyaresold
atalldrugstores,andyouwillwanttokeeptheminyourpurseorbriefcaseand
in your glove compartment. If your blood sugar check shows you are
hypoglycemic,youshouldtake15gramsofglucose.Ifyouhavetypicalglucose
tabletswith4gramsofglucoseeach,youwillneedtotakefourtabletsatonce.
Herearesomeothergoodchoices.
½cup(4ounces)ofanyfruitjuice
½cup(4ounces)ofaregular(notdiet)softdrink
5or6piecesofhardcandy
1or2teaspoonsofsugar
After15minutes,checkyourglucoseagain.Ifitisstillbelow70mg/dl(3.9
mmol/l),have anotherserving,thencheckagain inanother 15minutes.If you
arewithinanhourofmealtime,goaheadandeat.Ifnot,haveasnack.Besureto
carryglucose tabletsor aquick-energyfood withyou foremergencies,weara
medicalidentificationbracelet,andbeespeciallyattentivetoyourglucoselevel
duringexercise,whichcancausebloodsugartodrop.
Hypoglycemiacanalsooccurwhileyouareasleep.Lookforthesesigns.
Nightmaresorcryingout
Findingthatyourpajamasorsheetsaredampfromperspiration
Awakeningwithunusualtiredness,confusion,orirritability
Carl’sHypoglycemicEpisode
Carlhadbeentakingmetforminandglipizideforabout5years,andhismorningbloodglucose
valuesrangedbetween120and150mg/dl(6.7and8.3mmol/l).Hechangedhisdietwiththe
hope of coming off his medications, and in fact, very soon after he began this program, his
readingsbegan to drop. After about 2 weeks, they were often under 100 mg/dl(5.6 mmol/l).
Carlwasdelightedwithsuchclearevidencethatthechangeswereworking.
Abouta month into the diet,he had an unusual experience.One morning at about 10:00
a.m.,hefoundhimselffeelingunusuallyhungry.Healwayshadagoodappetite,butthiswas
somethingdifferent.Hefeltravenous.Overthenextseveralminutes,hestartedtotrembleand
brokeintoasweat.“Oh,yes,”hethoughttohimself.“Thisiswhattheytoldmemighthappen.”
Hecheckedhisbloodglucose,anditwas65mg/dl(3.6mmol/l),whichislowerthanitshould
be.Hehadsomeorangejuiceandanearlylunch.Hetelephonedhisdoctor,whoreducedhis
glipizide dosage. Over the next several weeks, the episodes repeated several times.
Eventually,hisdoctorstoppedtheglipizidealtogether.
Carl’s morning blood glucose readings stabilized at around 80 to 90 mg/dl (4.4 to 5.0
mmol/l). He never needed to go back on glipizide, and he never had another hypoglycemic
episode.
Iftheseoccur,youcancheckfornighttimehypoglycemia.Simplysetyour
alarmforabout2:00or3:00a.m.andcheckyourbloodsugarafewnightsina
row.Consultyourdoctortoseeifyouneedamedicationchange.
Hypoglycemiadoesnotmeanthereisanythingwrongwithyourdiet.Rather,
itmeansthatthemedicationregimenyouareonhasbecometoostrongforyou.
Thenextstepistocontactyourphysicianorothercaregiver,whowillprobably
reduce your medication dosages or eliminate one or more drugs. Get in touch
withyourdoctorassoonaspossible—thesamedaytheepisodeoccurs.Donot
put it off, because the hypoglycemic episodes are likely to recur until your
medicationsarereduced.
Totrackyourbloodsugar,usealogbookorasimplegridliketheonebelow.
BloodGlucose
DATE MEDICATIONREGIMEN EARLY BREAKFAST LUNCH DINNER LATE
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
/ / /
Note:Itisespeciallyhelpfultocheckyourbloodglucosebeforemeals.Markthesenumbersto
theleftoftheslashmarks.Markafter-mealvaluestotherightoftheslashmarks.
MAKINGSENSEOFGLUCOSE
Blood glucose values are a bit like the stock market: Although they generally
followatrend,theycanbouncearoundfromdaytoday.Certainsituationscan
triggeranunexpectedrise.Anysortofillnessorinfectioncanboostyourblood
glucose; even a minor upper respiratory illness or a scraped foot can cause a
significant jump in your numbers. Stress can, too, due to the action of stress-
relatedhormones.
Having some up-and-down swings in blood sugar is normal, but if your
glucoseremainshighdayafterday,yourriskofcomplicationsishigherthanit
would beif your glucose level werebetter controlled. The AmericanDiabetes
Associationrecommendsthatpeoplewithdiabetesusethefollowingguidelines
forbloodglucoselevels.
Fastingorbeforemeals:80to130mg/dl(4.4to7.2mmol/l)
Oneto2hoursafterameal:below180mg/dl(10.0mmol/l)
THEDAWNPHENOMENONANDTHESOMOGYIEFFECT
Youmayoccasionallybesurprisedtofindthatyourbloodglucoseishigherin
themorningthanitwaswhenyouwenttobedthenightbefore.Orperhapsyou
checkedyourglucoseintheearlymorningandthenwentbacktosleep,onlyto
findthatithadrisenwhileyouslept.Howisthispossible?
No,sugarplumsdancinginyourheadhadnothingtodowithit.Thefactis,
yourbodyconstantlymonitorsthe amountof glucosein yourbloodstream and
adjusts it from time to time. Glucose is vital to your body’s functioning—
especiallytotheworkingsofyourbrain—soyourbodyhasawayofincreasing
yourbloodglucosewhenitgetsabitlow.Intheearly-morninghours—typically
between 5:00 and 9:00 a.m.—hormones (growth hormone, cortisol, and
catecholamines)causeyourlivertoreleaseglucoseintothebloodstream.These
hormones can also interfere with insulin’s efforts to remove glucose from the
blood.This“dawnphenomenon”cannoticeablyraiseyourbloodsugar.
1
Asimilarreactioncanoccurwhenapersonusinglong-actinginsulinhasan
unusualbloodglucosedipinthemiddleofthenight.Let’ssay,forexample,that
youmissyourusuallate-nightsnack,andtheinsulinyouaretakingforcesyour
glucose level too low. Once again, your natural hormones will compensate,
raisingyourbloodsugar.ThisiscalledtheSomogyieffect.Itisdifferentfrom
thedawnphenomenoninthatitistriggeredbyanoverlylowbloodsugarlevel
occurringinthemiddleofthenight.
Althoughyourbodyhasasystemforcontrollingyourbloodsugar,itisabit
imprecise.Yourbloodsugarcanstillruntoolowortoohighdespiteyourbody’s
bestefforts,and youwill occasionallysee ahigh orlow levelthat youcannot
explain.
HEMOGLOBINA1C
As discussed in Chapter 1, the main test for assessing your progress is
hemoglobinA1C.YourA1Clevelshouldbecheckedevery6months,orevery3
months if your diet, medications, or general health is changing or if previous
valueshavebeentoohigh.IfyourA1Cishigh,yourdoctorwillbeconcerned,
andyoushouldbe,too.Ifitislow,youaredoingwell.Togiveyouaframeof
reference, the American Diabetes Association says that most people with
diabetesshouldkeeptheirA1Cbelow7percent.Alowertarget,say6.5percent,
makessense ifyoucangetthere withoutriskinghypoglycemia (thatis,ifyou
arenotonmedicationsthatarelikelytocausehypoglycemia).Ifyoudotendto
have frequent hypoglycemic episodes, your caregiver may recommend a less
stringenttarget,say8.0percent,inordertokeepyourbloodglucosefromfalling
toolow.
AtypicaloraldiabetesmedicationbringsA1Cdownbyanaverageofabout
1pointorabitless.TheeffectofagooddietonA1Cvariesdependingonhow
good your control is when you start, how well you follow the diet, and how
much excess weight you lose. Your result will also be affected by exercise,
genetics,andotherfactors.
Thebiggestdropswehaveseeninshort-termresearchstudiesarearound4
pointsinapproximately6months.TheseareseeninpeoplewhoseA1Cswere
high(say,9or10)tobeginwith.PeoplewhoseA1Csareinthe7to8rangeare
likelytohaveadropaveragingbetween1and2points.Peoplewhocontinueto
lose weight beyond this time could have an even greater drop, assuming they
werenotalreadyinthenormalrange.
The higher your A1C, the greater your risk of circulatory problems.
EvidencesuggeststhatkeepingA1Clowisparticularlyimportantforthehealth
ofyoureyesandkidneysandforpreventingnervesymptoms.
Fromyourheart’sstandpoint,a1-pointincreaseontheA1Cscale—from7
to8or8to9,forexample—bringsabouta20percentincreaseinyourriskof
heartproblemsoveraboutadecade.
2
Inotherwords,ifyouhada10percentrisk
ofhavingaheartattacksometimeinthenextdecade,a1-pointriseinyourA1C,
maintained over the whole decade, would boost your risk to 12 percent. A 2-
pointrisewouldmeana14percentrisk,andsoon.Whatthesenumberstellusis
thatA1Cisimportantand thatby allmeans,youwillwantto aimtogetyour
A1Cdown.However,A1Cisnotthesolekeytogoodhealth.Tostopdiabetes
fromattackingyourheartandbloodvessels,youwillalsowanttofocusonyour
blood pressure, cholesterol, and weight. Needless to say, your doctor can and
shouldtrackthesevalueswithyou.
CHOLESTEROL
Yourdoctorwillcheckyourcholesterolatregularintervals,atleastonceayear.
AsyouwillseeinChapter12,highlevelsofcholesterolinthebloodcandamage
yourheart,majorbloodvessels,andthedelicatebloodvesselsoftheeyesand
kidneys.Herearethenumberstoaimfor.
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Totalcholesterol.Accordingtomostauthorities,totalcholesterolshouldbe
below200mg/dl(5.2mmol/l).Isuggestyouaimforaconsiderablylowergoal,
however. First of all, the average cholesterol level in the United States is
hoveringaround200mg/dl,andinacountrywhereheartattacksarethecauseof
deathforhalfthepopulation,youdonotwanttobeanywherenearaverage!In
largepopulationstudies,itisclearthattheloweryourcholesterol,theloweryour
risk of heart problems, until you reach a threshold of about 150 mg/dl (3.9
mmol/l). My suggestion is to use that as your goal rather than the more
permissive“official”figure.
Low-densitylipoprotein(LDL)cholesterol.LDLcholesterolisoftencalled
bad cholesterol because it raises your risk of heart problems and other blood
vesselcomplications.Accordingtomostauthorities,yourLDLshouldbebelow
100 mg/dl (2.6 mmol/l). Your risk of heart problems drops as LDL decreases,
untilyoureachalevelofapproximately40mg/dl(1.0mmol/l).
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High-density lipoprotein (HDL) cholesterol. HDL cholesterol is often
called good cholesterol because it carries cholesterol out of the body. Some
evidencesuggeststhatthehigheryourHDLcholesterol,thebetter.Currentgoals
areto havean HDL levelabove 40mg/dl (1.0mmol/l)formenand above50
mg/dl(1.34mmol/l)forwomen.
Some doctors, however, interpret HDL in the context of your total
cholesterol concentration: In this case, a favorable HDL reading would be at
leastone-thirdofyourtotalcholesterol.Forexample,ifyourtotalcholesterolis
150,a healthyHDLwould be50 orabove.This isan importantconsideration
becausemanypeoplewhofollowhealthfuldietsdonothavemuchofanykind
ofcholesterol—LDL,HDL,oranythingelse.
RecentevidencehascalledtheimportanceofHDLintoquestion.Although
loweringLDLcholesteroldoesreduceyourriskofheartproblems,raisingHDL
doesnotseemtomakeanydifference.
Triglycerides. Triglycerides are tiny fat particles transported in the
bloodstream. Normal triglyceride concentration is less than 150 mg/dl (1.7
mmol/l).
SeeChapter12forinformationoncontrollingcholesterolandtriglycerides.
TRACKINGYOURBLOODPRESSURE
Maintaininghealthybloodpressureisextremelyimportant.Asyoucanimagine,
increased pressure inside your arteries can damage the arteries themselves, as
well as your heart, eyes, kidneys, and nerves. The longer your blood pressure
stayshigh,themoredamageitcando.
Problemscantravel intheotherdirection,too: Damagetothekidneyscan
leadtohighbloodpressure. Thereasonis thatyour kidneysplay animportant
role in regulating your blood pressure, and if they have been assaulted by
diabetes,theycanlosesomeoftheirabilitytodothis.
InChapter12,wewilllookathowdietaffectsbloodpressure.Fornow,here
areyourtargets.
Normalbloodpressureislessthan120/80millimetersofmercury(mmHg).
Ifyouhavehighbloodpressure,yourcaregiverwillworkwithyoutoreduceit
to below 140/90, and to below 130/80 if you can get there without serious
medicationsideeffects.Ifyouarepregnant,thetargetwillbe120–160/80–105,
aimingtoprotectbothyouandyourbaby.
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It goes without saying that diet changes are key for controlling blood
pressureandcanoftenmakemedicationsunnecessary.Thesameplant-baseddiet
thathelpsyouloseweightandbringsdownyourbloodsugarwillalsohelpyou
controlyourbloodpressure.
Haveyourbloodpressurecheckedregularly.Ifitisnotwhereitshouldbe,
take another look at your diet and speak with your doctor about what, if any,
additionaltreatmentsyoumayneed.Ahealthfuldietandtheweightlossitbrings
canalsomeanthatyourcaregiverwillcutbackonbloodpressuremedicinesyou
maybeon,orstopthemaltogether.Butdon’tstopyourmedicinesonyourown.
CHECKINGYOURKIDNEYHEALTH
Becauseyourkidneyscaneasilybeaffectedbydiabetes,yourdoctorwillcheck
yourkidneyhealthwithasimpleurinetestatleastonceayear.Thegoalistosee
whetheryour kidneysare losingprotein, specificallya proteinmolecule called
albumin.Albuminitselfisnotespeciallyimportant.Whatisimportantisthatifit
shows up in your urine, it is a sign that your kidneys have been affected by
diabetes and are not holdingonto albumin as they should. Albumin losses of
greaterthan30milligramsover24hoursareconsideredabnormal.Yourdoctor
willalsocheckyourbloodforcreatinineandestimateyourglomerularfiltration
rateandwillinterprettheresultsofthesetestsforyou.Formoreonfactorsthat
influencekidneyhealth,seeChapter13.
OTHERROUTINELABORATORYTESTS
Your doctorwill run other tests totrack your progress. The followingare two
verycommonones.
Completebloodcount(CBC).Thistestshowsthestateofyourbloodcells.
Manypeoplewithdiabetesdevelopanemia,meaningtheyhavefewerredblood
cellsthantheyshould.Acompletebloodcountletsyourdoctoreasilycheckthis
and many other measures. If your blood count is low, your doctor will
investigate the reasons for it, which could include kidney disease, iron
deficiency,useofcertainmedications,abnormalbleeding,orotherfactors.
Chemistrypanel.Aroutinechemistrypanelisalsoknownbyseveralother
names.Itassessesyouroverallhealth,withaspecialfocusonthestatusofyour
kidneys and liver and lets doctors check for potential adverse effects from
medications.
Thereisnoreasontodespairifanyofyourlaboratoryvaluesarenotwhere
they should be, but it is definitely a reason to take action. You will want to
optimizeyourdietandworkwith yourdoctorto plota coursefortrackingthe
effectivenessofyouroverallhealthregimen.
TAKINGSTOCKOFYOURDIET
Iwould like toshift gearsnow andlookat yourdiet andoverall health.First,
let’stakeaminutetomakesurethatyourdietisgoingaccordingtoplan.
Areyourfoodsvegan?Youknowyouaredoingwelliftherearenofoodsof
animaloriginonyourplate,notevenlittlebitsoffish,fat-freemilk,oregg
white—nothing. If you have done this right, there is no animal fat, no
cholesterol,andnoanimalproteininyourdiet.Yourmenuisbuiltfromplant
foods,anditisrichinfiberandallthehealthynutrientstheplantkingdom
bringsyou. Ifyou needa refresheron whyyou aredoing this,please take
anotherlookatChapter4.
Areyourmealsalllowinfat?Itisimportanttoreallykeepfatsandoilstoan
absoluteminimum.Becarefulwithnutsandnutproducts.
Are your foods low GI? The main problem foods are sugar, corn syrup (a
common sweetener in processed foods), white and whole wheat breads
(favor rye and pumpernickel), and baking potatoes (choose sweet potatoes
andyams).
QUICKFIBERCHECK
OnewaytohelpgaugehowyouaredoingiswiththeQuickFiberCheck.Itisa
handylittletool,andIsuggestthatyoudooneaboutonceaweekasyoubegin
thisnewapproachtoeating.Scoringissimpleandtakesonlyaminuteortwoto
learn. Soon, estimating the fiber content of virtually everything in the
supermarketwillbeasnap.Youwillalsoseeifyouaregettingenoughfiberin
your daily menu. It doesnot take long, and it will help you see if you areon
track.
First,takeaminutetojotdowneverythingyouateordrankfor1fulldayon
aformsimilartotheexamplebelow.Iwillexplainbelowhowtofillinthefiber
column.
Then,nexttoeachfood,noteitsfiberscore,usingthefollowingguide.
Beans: For each serving of beans or lentils (one serving = ½ cup) or any
food that includes about this amount of beans or lentils as an ingredient, give
yourselfa7.Onecupofsoymilkor½cupoftofu(bothmadefromsoybeans)
ratesa3.
Vegetables: For each serving of vegetables (one serving = 1 cup), give
yourselfa4.Anexceptionislettuce,forwhich1cupscoresa2.Apotatowith
skinscoresa4;withouttheskin,a2.
Fruit:Foreachmediumpieceoffruit(e.g.,anapple,orange,orbanana;1
cupapplesauce;abananasmoothie),marka3.For1cupofjuice,marka1.
Grains: For each piece of white bread, bagel, or equivalent, score a 1.
Wholegrainbreadsscorea2,asdoes 1cupof cookedpasta.One cupofrice
scoresa1forwhiteanda3forbrown.Onecupofcookedoatmealscoresa4.
Scorea3fortypicalready-to-eatcereals,a1forhighlyprocessedandcolored
cereals,andan8forbran.
Soda,water:Scorea0.
InterpretingYourScore
Totalyourfiberscoreandlet’sseehowyouaredoing.
Lessthan20:Youneedmorefiberinyourdiet.Asitis,yourappetitewill
be hard to control, and you may have occasional constipation. Boosting fiber
willhelptameyourappetiteandcutyourriskofmanyhealthproblems.
20–39:You aredoing betterthanmost peoplein Western countries,but as
you bring more fiber into your diet, you will find that it makes foods more
satisfyingandcutsyourcalorieintakeabit.
40ormore:Congratulations!Youhaveplentyofhealthyfiberinyourdietto
controlyourappetiteandhelpkeepyouhealthy.Fiberalsoreducesyourriskof
developingcancer,heartdisease,diabetes,anddigestiveproblems.
CHECKINGYOURWEIGHT
Of all the things that predict success in dealing with diabetes, leaving behind
excessweightisamongthemostimportant.ThestrategyoutlinedinChapter6is
ahighlyeffectivewaytogoaboutit.
Herearesometipsfortrackingyourprogress.
First,trackyourweight.Somepeoplewhohavebeenoverweightforalong
time have not gone near a scale in years. If that sounds like you, give it
another try. It is essential to know if you are losing. If you are not losing
weight,itistimetochangecourse.Usually,thatmeanstuningupyourdiet.
Weightlossissometimesdifficult,andgenetictendenciesdoplayarole,but
yourdietisonethingyoureallycancontrol.
Usethesamescaleeachtimeyouweighyourself.Differentscalescangive
dramaticallydifferentreadings.
Checkyourweightatthesametimeofdayeachtime.Withfoodandwater
intake, you can easily gain and lose a few pounds in the course of a day.
Usually,youwillbeheavierintheevening.
In gauging the success of your weight loss, about 1 pound per week is a
healthful goal. It is about what you can expect if you follow the diet
presentedinthisbookwithoutdoingparticularlyvigorousexercise.Slower
weightlossisalsofineaslongasyouaremovingintherightdirection.
Do notrelyon exercise alone forweight loss. A healthful dietchange can
easilytrim300to400caloriesadayoffyourdailymenu,butburningthat
manycaloriesthroughexercisemeanswalkingorrunning3or4milesaday.
Exerciseisimportant,butitcannotbegintotaketheplaceofdietchanges.
CHECKINGYOUREYES
Atleastonceayear,youshouldhaveaneyeexaminationbyanophthalmologist
to check for any sign of retinopathy. These changes cannot be detected by an
ordinary eye examination with a doctors ophthalmoscope or during an
optometricexamination foreyeglasses.Also besure tosee aneyespecialistif
youhavehadanychangesinyourvision.
Ifyousmoke,tellyoureyedoctor.Yes,youwillgetalecture,anditistime
to listen up if you are still smoking. See Chapter 13 for information on the
effectsofnutritiononeyehealth.
CHECKINGYOURFEET
Footproblemsarecommonindiabetes.Ifyour bloodglucose hasbeen poorly
controlled, you are at risk of developing neuropathy—nerve damage—which
meansyoumaynotbeawareofsmallinjuriestoyourfeet.Woundhealingmay
beslowedaswell.Smallinjuriescangraduallyworsenandbecomeinfected.
Forthisreason,younotonlywanttogetyourdietintoshapebyfollowing
theguidelinesinthisbook,youalsowanttohaveyourdoctorcheckyourfeetat
leastonceayear.Theexaminationwillincludeacheckforsensationusingathin
plasticthread,acheckofyourvibratorysensewithatuningfork,andathorough
check for any signs of damage to your skin. Take the advice of Mary Ellen
Wolfe, RN, a nurse working with George Washington University, who
recommendsthatyoutakeoffyourshoesandsocksateverydoctorsvisittobe
sureyourdoctordoesnotforgettoexamineyourfeet.
STAYINGHEALTHY
Nomatter howhealthyyou get,youshould stillkeepaneyeon yourglucose,
A1C,andcholesterol;bloodpressure;weight;eyes;andfeet.ButIhopeasyou
tuneupyour dietandlifestyle,that it’sallyouwill bedoing—justconfirming
thatallisjustasitshouldbe.
CHAPTER8
APerfectDietinanImperfectWorld
Itisnotalwayseasytofollowaperfectdietinanimperfectworld.Therewillbe
times when those you depend on—restaurants, airlines, co-workers, and even
familymembers—havelittleunderstandingoforinterestinhealthyfoods.This
chapter is dedicated to these situations. I will cover dining out, travel, social
situations,workingwith yourdoctor,and dealingwithfamily members.When
lifethrowsyouacurve-ball,Iwillshowyouhowtostepuptotheplateandstay
inthegame.
DININGOUT
Diningoutispartoflife,andyououghttobeabletoenjoyanightonthetown
with friends or loved ones without missing a beat on your new healthy diet.
Luckily,manyrestaurantmenusofferplentyofhealthyselections.Unfortunately,
othersarelimited.Oftenthekeytosuccessliesinwhereyougoandwhatyou
orderwhenyougetthere.Hereareafewtips.
First, think international. In Mediterranean countries, Asia, Africa, and
Latin America, the traditional dietary staples are grains, vegetables, legumes,
andfruits.Notsurprisingly,alloftheseregionshavehistoricallyhadmuchlower
rates of diabetes than North America and Western Europe. When you choose
fromthebestofwhatthesecuisineshavetooffer,dinneroutcanbebothhealthy
anddelicious.
Italian restaurants are everywhere, and they would love to serve you
spaghetti with a marinara or arrabbiata sauce, minestrone, pasta e fagiole (a
traditionalsoupmadewithpastaandbeans),healthysalads,chunkyvegetable-
and-tomato pizza,grilled asparagus, and steamedspinach. Because their foods
areusuallymadetoorder,itisasnapforchefstominimizeoil,leaveoffcheese,
servesaucesontheside,andsoon.
Mexican restaurants are ubiquitous in North America and serve bean or
vegetableburritos,veggiefajitas,rice,andsalads.Mosthavestoppedusinglard
tomaketheirbeans,andallarehappytoskipthecheese.Topfoodswithsalsaif
youlike.
LatinAmericancuisinecomesinotherwonderfulvarieties,too.Cubanand
Brazilian restaurants offer black bean dishes, rice, plantains, salads, salsa, and
otherhealthfulfare.
Chinese restaurants will get you started with vegetable spring rolls or
vegetablepotstickers andvarioushealthy soups.Favorthe steamed,notfried,
items. Skip the meat dishes and get right to the long list of savory vegetable
maindishes made withtofu (alsoknown asbean curd), greenbeans, broccoli,
spinach,andotherhealthfulingredients.ThedangerinChineserestaurants,asin
mosteatingestablishments,isoverexuberancewiththeuseofoil.Askthatyour
foodbepreparedwithaslittleoilaspossibleandhaveyourmaindishalongwith
plentyofrice,preferablybrownrice.
Japanese restaurants are among the very best choices when it comes to
healthful dining. Sushi chefs are delighted to transform carrots, cucumbers,
radishes,sweetpotatoes,andothersimpleingredientsintoedibledelights.Have
themalongwithmisosoup,salads,seaweed,andvariousappetizers.
Thai and Vietnamese restaurants serve many meatless dishes that include
rice,softnoodles,vegetables,andtofualongwithwonderfulsauces.
Indian restaurants are mixed. While vegetarian diets are traditional and
highly respected among many Indians, the use of oil and dairy products often
puts them in the no-go zone. Your best choices are soups, rice dishes, and
vegetablecurriespreparedwithminimaloil.
Ethiopianrestaurants arecommon in majorcities. Becausesome religious
groups in Ethiopia follow vegan diets during certain days of the week and
certaintimesoftheyear,therestaurantsservemanydishesmadewithchickpeas,
split peas, lentils, green beans, peppers, and delightful spices. They will be
happytoserveyoualltheirveganitemsonalargeplatterforawonderfuldinner.
Americanrestaurants, family restaurants,and even steakhouseshave salad
barsandoffervegetableplates.Manyservepastadishesevenwhentheyarenot
onthemenu.
Second,askforwhatyouwant.Ifwhatyouarelookingforisnotonthe
menu, do not be afraid to ask. Most restaurateurs will gladly alter their main
offeringstoaccommodateaspecialrequest.Ifyouwouldlikecheeseandbacon
bitsleftoffyoursalad,ifyouwouldlikeavegetableplate,orifyouwouldlike
yourpastatopped withtomatosauceinstead ofmeatsauce,by allmeans,ask.
You will not only get a better meal, you will also help the restaurant
managementunderstandhowtobetterservepatronslikeyou.
AsInotedabove,restaurantkitchensoftenoverdoitwithoils,soaskyour
serverhowfoodsarepreparedandrequestthatyourmealbemadewithaslittle
oilaspossible.InItalianrestaurants,spinachandbroccoliareoftensautéed,but
theycanalsobesteamed.ThesamegoesformostAsianvegetabledishes.
Saucesandcondimentscanalwaysbeservedontheside.Thisgoesforpasta
sauces, salad dressings, brown sauces used in Asian cuisine, spreads used on
sandwiches,andsimilaritems.
Askforwhatyouwant.Youwillbegladyoudid.
ABreakfastTrick
mostrestaurantswillgladlyserveahealthfulbowlofoatmealforbreakfastand
will top it with strawberries, blueberries, or cinnamon. But once in a while,
you’llfindpreciouslittleateateriesthatarebusyservingbaconandeggs.Here’s
atrick:
Ask the server to have the cook throw some tomatoes, spinach, and
mushroomson thegrill. Maybesome asparagus,too. Chefsare accustomedto
stuffingthemintoomelets;now,you’rejusthavingthemwithouttheeggs!With
asideofryetoast(nobutter,ofcourse),you’reset.
FastFood
Fastfoodisrarelyatopchoicewhenthepriorityishealthyeating.Ontheother
hand, these chains are big businesses that understand the growing demand for
healthyfood choices.More andmoreoften, youfind offerings ontheir menus
thatfitintoahealthydiet.
TacoBell’sbeanburrito—ifyouholdthecheese—isentirelyvegan.Ifyou
like,addtomatoes,lettuce,orjalapeñochilepeppers.
BurgerKingoffersaveggieburgerthatis muchlower infatthanits other
sandwichesandwillalsogladlysellyouaVeggieWhopperwithallthetoppings
butwithouttheburger.Submarinesandwichshopswillgladlyleaveoffthemeat
and cheese and pile on the lettuce, tomato, cucumbers, spinach, and peppers,
plus a dash of red wine vinegar. And they will even toast it for you. Denny’s
offers a veggie burger, and most family restaurants serve plenty of side
vegetablesthattogethermakeagoodvegetableplate.
Some fast-food restaurants offer salad bars. With chickpeas, three-bean
salad,cherrytomatoes,andchoppedvegetables,asaladbecomesaheartymeal.
Inthatvein,oneofthebest waystoget healthyfoodfast istostop atany
largesupermarketandpatronizeitssaladbar.Awealthofgreatchoicesisrightat
yourfingertips.
NANCY’SANDVANCE’SEXPERIENCES
Nancy often dined with friends who liked good food and good restaurants. I
encouragedhertochooseethniccuisine—Chinese,Japanese,Italian,orThai,for
example.Unfortunately,thatwasnotwhatmostofherfriendshadinmind,and
theyfeltuncomfortableknowingshewouldnoteatunhealthythings.
Whenshe headedout tojoin friendsat arestaurant thatmight notbe very
accommodating,sheoftenhadasnackinadvancesoshewouldnotbestarving
whenshegotthere.Whenshewenttoopenhousesduringthewinterholidays,
sheoftenvolunteeredtobringafruitandvegetabletray.
Ona vacation toIceland, shepacked granolabars and individualsoy milk
packagesinherluggage,tosupplementthelocalfood,andgotbyjustfine.
“Iamtemptedsometimes,especiallywhenIamstressedorovertired.Italk
myselfoutofit,”shesaid.
Shefoundithelpfultokeepthingsinperspective.“Youhavetodecidewhat
yourprioritiesare,”sheexplained.“Ididn’twanttosufferfromtheeffectsofthe
disease.Iwantedtostoptheprogression.Ididn’teventhinkaboutreversingit.
AndnowI’mawalkingadvertisementfortheprogram.Peoplekeepaskingme
howI’vedoneit.I’vedescribeditindetailtoprobably40people.”
When Vance dined out, he looked for veggie burgers, fresh steamed
vegetables, and pasta without cheese and oils. His challenge was sports
stadiums.“Ilovegoingtobaseballandfootballgames,wherefrenchfries,hot
dogs,andsoftdrinksareaboutallthat’soffered.Itwouldbegreattobeableto
bringinhealthyfoodorevenjustsomecarrotsticksandabottleofwater,but
usuallytheydon’tallowanyfoodtobebroughtin.SoatfirstIstucktopretzels,
popcorn,andCrystalLight.AtagameinSeattle,Ismelledthefishandfries,and
itwashardtoresist,”hesaid.
VeggiehotdogsandburgerscametoVance’srescue.Althoughtheyarenot
necessarilytheultimatediningexperience,theyareamajorimprovementonthe
foods they replace, and more and more stadiums, movie theaters, and other
venuesarestartingtosellthem.
TRAVEL
Travel presents challenges no matterwhatkind of diet you follow. Here are a
fewwaystohelpkeepyourneweatingplanontrack.
Choose restaurants wisely. As you have seen, there are usually plenty of
vegan choices at nonvegan restaurants, particularly those that feature
internationalcuisine.Evensomefast-foodplacescanrisetotheoccasion.
Youmightgoonlinetocheckoutveganandvegetarianrestaurantsincities
you are planning to visit. A Web site called Happy Cow’s Vegetarian guide
(happycow.net) lists them by location, but call before you go; restaurants are
forever starting up and shutting down. There’s no reason to limit yourself to
these restaurants, though; almost any eating establishment should be able to
accommodateyou.
Plan before you fly. When you are booking an international flight (or
generallyupto48hoursbeforeyourflight),requestaveganmeal.Youwillgeta
healthymealandwilloftenbeservedfirst.
On domestic flights, most meal service has gone by the wayside, so you
mightpickupsomeeasy-to-packsnacksatahealthfoodstoreorsupermarket.
Vegan deli slices are great sandwich fillers and resist spoiling. A pack of
hummuswithpitabread,afewpiecesoffreshfruit,somebabycarrots,instant
soup cups(flight attendants willgladly provide hotwater),or a smallpop-top
canofchickpeascanbelifesavers.
SOCIALEVENTS
It can be tough to stick to the plan at parties, even when you know you will
regretaslipinthemorning.Ifyouarriveatapartyunprepared,theremaywell
benothing availablethat youcan eat.With abit ofplanning, though,you can
celebratewithoutleavingthehealthypathyouareon.Herearesomeideas.
Offertobringahealthydish.Let’ssayyouhavebeenaskedtothehomeof
somefriendsfordinner,andyouhavenoideawhattheywillserve.Hereiswhat
Isuggest:Whenyougettheinvitationorassoonthereafteraspossible,callyour
hoststoletthemknowthatyouhavechangedyourdietandthatyoudonotwant
toputthemtoanytrouble.Saythatyouwouldliketobringsomething,suchasa
low-fat hummus dip or an exotic fruit salad. I can almost guarantee that your
hostswillsaythereisnoneedtoworryandyouneednotbringanythingbecause
therewillbe plentyto eat. Now, regardless ofwhat they werereally thinking,
youhavealertedthemtoyourneedswithoutimposingintheslightest.
If you are reluctant to let your hosts know, do not be. They will be much
moreembarrassed iftheyfind outafterthe factthatthey serveda dinnerwith
nothingyouwantedtoeat.Besides,youareverylikelytofindthatotherguests
—andevenyourhosts—aremakingsimilardietchanges.
Bringahealthygift.Insteadoftheusualbottleofwine,whynotarrivewith
ahealthfulfoodgift?Afruitbasket,aloafofartisanpumpernickelbread,ora
healthy party dip (you can find all of these at health food stores) will delight
yourhostsandensurethatyouhavesomethingtoeat.
Avoid arriving hungry. If you arrive ravenous, you will be drawn to the
plattersofunhealthfulfoods.Ifyoueatsomethingbeforeyouarrive,youwillbe
fine.
Carryaplate.Partyguestswithnothingintheirhandsareinvitingothersto
offer them something. Make yourself a plate with a few crudités or a bit of
bread,andnoonewillbeinclinedtoofferyoufoodsyoudonotwanttoeat.
ATTHEDOCTOR’SOFFICE
Medicalcareisapartnership;youandyourdoctorneedtoworktogethertobest
meet your needs. This is true at any time, but especially when you are in the
process of changing your diet. The fact is, your diabetes will probably be
improving,andyouwillneedtoratchetdownyourmedications.
Some doctors are not easy to reach, and even if you have your doctors
attention,thatdoesnotmeanheorshewantstoengageinaconversationabout
nutrition. Some physicians show little interest in the topic, while others have
franklyoutdatedoruntestedideasaboutit.
Isuggestyoulendacopyofthisbooktoyourphysicianwithastickynote
flaggingChapter14. It was written fordoctorsand shows them how they can
besthelpyou.
You can help by holding up your end of the partnership. That means
following your doctors advice (provided it is sound and you agree with it),
letting him or her know how you are doing, calling promptly if your blood
glucose drops below 70 mg/dl (3.9 mmol/l) or whatever other criterion is set,
and taking a vitamin B
12
supplement so he or she will not worry about your
developinganysortofdeficiency.Thetruthis,yournutritionismuchbetterona
vegandietthanonanomnivorousdiet,butaknowledgeabledoctorwillwantto
besureyouaregettingyourB
12
.Asupplementwilleasilytakecareofthat.
In the vast majority of cases, doctors are delighted when their patients
improve their diets. They are all the more delighted when they see the
improvementsonthescaleandinlaboratoryresults.
Oneofourresearchvolunteersthoughthisdoctorwouldbeskepticalabout
hisplans.Theytalkedaboutlittleasidefrombloodtestsandprescriptionsduring
hisappointments. To hissurprise,however, whenthe doctorfoundouthewas
starting a vegan diet, she was delighted. “That will probably help you a great
deal,”shesaid.Andindeed,itdid.Within6months,helost30pounds,wasable
tostoponeofhistwodiabetesmedications,andwascontinuingtoimproveweek
byweek.Hisdoctorhadnoformaleducationinnutrition,butsheknewsuccess
whenshesawit.Shenowrecommendsthesamediettootherdiabetespatients.
LOVEDONESWHOHELPANDHURT
Sometimesourfriendsandfamilymembershelpusstayonahealthypath.When
we are not enthusiastic about exercising, they encourage us by going with us.
When we are tempted by some less-than-healthful food, they shore up our
resolve.
Improvingourdietsislikequittingsmokingorbreakinganyotherhabit:We
needour family’s support.But sometimes,intentionally orunintentionally,our
lovedonesarenotsohelpful.Theymaynotbeawareoftherisksofabaddiet,
orperhapsthey arealltooaware andarestrugglingwith unhealthfulhabitsof
theirown.Theymayeventrytosabotageyoureffortstobreakbadhabits.
Iftheproblemisthatyourlovedonessimplydonothavemuchinformation
abouthealthfuldiets,lendthemthisbook.Iftheyarenoteagerreaders,trythis
littletrick:Putastickynoteorbookmarkatanypageyouthinktheywouldfind
of special interest. They will be drawn to that section, and once they start
reading,theywillprobablycontinue.
If family members tease you about your eating habits, remind them how
important your health is to you. Explain that it is tough for you to have
unhealthfulfoodsaroundand thatyou reallyneed theirhelp. Ideally, they will
joinyouinyournew,healthywayofeating.Iftheyjustwillnotchange,thenat
aminimum,theymustkeeptheirfoodseparateandnotteaseortemptyouwith
unhealthyitems.
GOODFOODFORTHEWHOLEFAMILY
Ifyouarepreparingmealsforyourfamilyandtheyarebalkingatnewfoods,do
not despair. It is natural to be cautious about anything new. Present healthful
foods without pushing them andrecognizethat it often takes a couple of tries
beforeanewitemreallycatcheson.
I suggest that you not fix healthy meals for yourself and less-than-healthy
meals for your spouse or children. Some people do this, figuring they cannot
change others’ bad habits. But remember this: Not only will introducing
healthful foods to your family bring you some very important allies, it will
benefityourlovedonesaswellasyou.
Theverybestsituationiswhenthewholefamilydecidestochangetogether.
Thereisnohealthreasonforanyonetoeatanimal-derivedfoods,fattyfoods,or
sugaryfoods.Yes,thesefoodsareeverywhereinmodernsocieties,buttheyare
theprincipalreasonfortheepidemicsofoverweight,heartdisease,cancer,and
otherhealthproblemsinNorthAmericaandmuchoftherestoftheworld.When
thewholefamilymakesthesamedietchange,theyallgetthesameadvantage.
Onegoodwaytobreakthroughresistanceistoaskyourfamilymembersto
tryashort-termdietchangewithyouasanexperiment.Saythatyou’dliketotry
newand healthy waysof eatingfor just3 weeks, andyou wouldlike themto
joinyou.Mostpeoplewilltryanythingforashortperiod.Bythetime3weeks
havepassed,theywillhavesortedoutthenewfoodstheylikeandwillbeready
formore.
Whenintroducinghealthfulfoodstochildren,itisgenerallybesttostickto
simple,familiaritems.Somechildrenmaynotyetcareforexoticvegetables,but
they will easily gravitate to fruit of all kinds, as well as corn, green beans,
carrots, peas, and other simple foods. Avoid wrangling with a child who is
reluctant to try a new food. Sometimesaltering the form of the food makes a
huge difference. A child who does not care for the texture of cooked spinach
maylikefreshspinachaspartofasalad.Steamedbroccoliandcauliflowermay
beintimidating,buttheymaybeperfectlyacceptablewhenchoppedandadded
toasouporstew.Kidsmaynotgoforlentilloaf,buttheyloveveggieburgers
andhotdogsandsandwichesmadewithvegetariandelislices.
Italwayshelpstopresentchoices.Wouldyourchildrenpreferbakedbeans
or lentil soup? Would they prefer their veggie burgers cut into halves or
quarters?Theideaistogivekidsasenseofcontrolwhileallthepossibilitiesare
goodones.
Insomefamilies,foodisasymbolofaffection.Parentsstufftheirchildren
with cookies and gooey desserts, as if love could be measured in calories.
Whateverthemotivation,noneofthisdoesyouonebitofgood.Findotherways
toexpressaffection.Abook,awalk,atriptothemovies—thereisnoshortageof
meaningfulgifts.
HEALTHFULFOODSINANUNHEALTHYWORLD
Avisitorfromanotherplanetmightwellconcludethatmoderncivilizationhas
no perceptible interest in healthful diets. Fast-food restaurants—and regular
restaurants—carrylotsoffatty,cholesterol-ladenmealsand farfewerhealthful
choices. Television commercials push endless less-than-healthful snacks.
Conveniencestoresandsnackmachinesofferlotsofwhatyoudonotwantand
preciouslittleofwhatyoudowant.Sometimes,youmayfeellikeapersonwho
istryingtoquitsmokingbutistrappedinabarwherecigarettesarefree.
Inlargepart,youwouldberight,buttruly,therearealsoplentyofhealthful
options. For every convenience store selling unhealthy food, there is a
supermarket with an ever-expanding range of great food products. For every
restaurantthatrefusestoserveanythinghealth-consciouseaterswouldlookfor,
there are a dozen that offer good choices. The range of health-oriented
cookbooksistrulyenormous,anditisnoweasierthanevertofollowahealthful
diet.Friendsandfamilymembers—eventhosewhodonotfollowhealthydiets
themselves—allknowthatwhatyouaredoingisworthsupporting.
CHAPTER9
Troubleshooting
Howareyoudoingwithyournewwayofeating?Areyoureachingyourweight-
loss goals? Are your glucose and A1C coming down? Is your cholesterol
improving?
Ifyouarehavinganysortoftrouble,thischapterwillguideyouthroughthe
mostcommonproblemspots.
NOTLOSINGWEIGHT
People who begin low-fat, vegan diets typically lose weight easily. In our
researchstudies,theaveragerateisabout1poundperweek.Somepeoplelose
morequickly,othersabitmoreslowly,butapoundaweekisagoodpace.Ifyou
think about what this means over a years time, the result is impressive,
particularly since you are free of the yo-yo syndrome that comes with diets
based on calorie restrictions. Because this is not a short-term, starve-yourself-
thin diet, it does not cause hunger, so there is no rebound bingeing. Gradual,
healthyweightlossiswhatyoucanexpect.Sometimeslosingweightcanbea
bitlikefollowingthestockmarket.Therearefluctuationsupanddown,butthe
trendshouldbeclear.Ifyouarenotlosingweight,itistimetotakeaction.Here
arethestepstotake.
Getbacktothebasics.BesureyouarefollowingtheguidelinesinChapter
4andgivingit100percent.Thatmeansnoanimalproductsinyourdietatall.If
yourdietincludesfishor cheese,for example,yourweight-losseffortswill be
hampered.
Checkforhiddenoils.Packagedfoodsshouldincludenomorethan3grams
offatperserving.Ifyoufrequentlyeatatrestaurants,trytoassesstowhatextent
they are packing oils into their meals. If you are unsure (or your server is
unsure), ask for foods to be steamed rather than fried or sautéed and that any
saucesordressingsbeservedontheside.SeeChapter8.
DoaQuickFiberCheck.Ifyoucheckyourfiberintakeandfindthatyou
are eating less than 40 grams of fiber per day, you’ll want to bring in more
beans,vegetables,andfruits.
Ifyourdietisvegan,lowinfat,andhighinfiber,itisveryhardnottolose
weight.Evenso,hereareafewthingstoconsider.
Simplify.Itpaystochoosesimplefoodsratherthanprocessedfoodproducts.
The fewer ingredients, the better—one is ideal. Beans, broccoli, carrots, or
brownrice,forexample,donotneedaningredientslist,becausewhatyouseeis
exactlywhatyouget.Youknowthatnoonehasaddedanyoilorprocessedaway
anyfiber.
Addmoreraw foods. Somepeople have had remarkableweightloss as a
resultofincreasingtheirintakeofrawfoods.Choppedvegetables,salads,fresh
fruit—theseareallrichinfiber,withnoaddedfatandlowGIs.
Don’tGetSidetrackedbyRationalizations
Sometimes people who are not losing weight blame genetics,lack of exercise, or something
elsefortheirproblem.Geneticsandexercisedoplayroles,ofcourse.Butifyouarenotlosing
weight,theproblemisnearlyalwaysdietary.
Once,enroutefromWashingtontoLondon,Iwasbusilytypingawayonmylaptop,writing
anarticleaboutdietchangesforweightloss.Thepassengernexttomehappenedtoseewhat
Iwas typingandtookan interestinthe topic.Hehadbeen overweightforseveral yearsand
wantedtoseewhatImightsuggest.Iexplainedourresearchfindingsabouthowdietchanges
couldcauselastingweightloss.Ipointedoutthatthekeyseemedtobechangingthetypesof
foods we eat. I launched into a discussion of the benefits of vegetables, fruits, beans, and
wholegrainsandthewonderfulmealstheycanbecome.
“That’s interesting,” he said, “but I think I just need to exercise more. That’s my real
problem.I used toexercise a lot,but lately, I’ve been so busy.”He brushed aside the whole
topicoffood.
Afewminuteslater, theflightattendantcamebywiththemealservice.Sheservedhima
ham-and-cheesesandwich,abagofchips,andasoftdrink,whichheshoveledintohismouth
withoutaword.Isuspecthedidnotrealizethatitwouldtakeaverylongsessionatthegymto
burnawaythoseunnecessarycalories.Theairlinealsoservedvegetarianmeals,whichwould
havebeenamuchbetterchoice.
Shortly thereafter, I was talking to a patient with Stanley Talpers, MD, an internist on the
faculty of the George Washington University School of Medicine in Washington, D.C. The
patientsaidhehadn’tbeenlosingweight,andhefiguredthathejustneededtowalkmore.Dr.
Talpers encouraged him to get his diet in order first because, he said, “to lose a pound by
walking, you’d have to walk to Baltimore.” It is true. Exercise is beneficial, and I strongly
recommend it. But a lack of exercise is not the primary reason for weight problems, and
exercisecannevertaketheplaceofahealthfuldiet.
BLOODGLUCOSENOTCOMINGUNDERCONTROLQUICKLY
ENOUGH
TheprimarywayoftrackingyourglucosecontroliswithhemoglobinA1C.As
youknow,theAmericanDiabetesAssociation’sgoalistohaveyourA1Cunder
7.0 percent. If you are not making good progress toward your goal, here are
somepointstoconsider.
Get back to the basics (again). If you are overweight, weight loss is the
strongestpredictorofahealthydropinA1C.Tojump-startweightloss,takea
look at the tips above and in Chapter 6. Whether you are overweight or not,
thosesamepointsarealsothekeystobringingyourglucoseundercontrol.
If your diet is vegan, it has no animal fat in it, of course. And if you are
setting aside vegetable oils, it has very little of any kind of fat. With these
healthychanges,youcanjustimaginethoselittlebitsoffatinsideyourmuscle
cellsstartingtoshrivelup.AsyousawinChapter2,thesearethebitsoffatthat
appeartobethecauseofinsulinresistance.
Embrace healthy carbohydrates. Many people tie one arm behind their
backsbyavoidingstarchyfoods.Theyimaginethatbeans,lentils,pasta,sweet
potatoes,oryamswillpushtheirbloodglucoseupward.And,ofcourse,ifyou
checkyourbloodglucoseafterjustaboutanymeal,itwillbehigherthanitwas
before.However,don’tletthisturnyouagainststarchyfoodsandbacktoward
fattyorhigh-proteinfoods.Hereiswhy.
Thefatinfishandchickenwilltendtoarrestyourweightloss.Itwillalso
tendtoaggravateyourinsulinresistance.Hereiswhathappensinatypicalcase.
A man has heard that “carbs are bad” or perhaps notices that his blood
glucosehasgoneupbrieflyafteramealofriceorstarchyvegetables.Hedecides
toavoidcarbohydratesandaddsfishandchickenbackintohisdiet.Atfirst,it
seemslikeagoodchange.Hisbloodglucosedoesnotspikestronglyaftermeals
because there is very little starch in his meals to provide glucose. “Aha!” he
says.“I’vefoundthediettokeepmybloodsugardown!”overthenextseveral
days,however,henoticesthathisfastingbloodglucosevaluesareheadinginthe
wrong direction. They go up bit by bit, and after a week or two, the rise is
significant.“Nowwhat?”hethinks.Thisiswhatisgoingon:
There are only three sources of calories: carbohydrate, fat, and protein. In
avoiding carbohydrate, he was left with fat—which tends to increase insulin
resistance—andprotein,whichhasproblemsofitsown.Theincreasedfatintake
didnotincreasehisbloodglucoseimmediately,butfattydietstendtoincrease
theamountoffatinsidethecells.Theresultisthatinsulinresistancegradually
worsens. This means that any carbohydrate he ate later would cause a bigger
bloodsugarspikethanitotherwisewouldhave.Asthedayswentby,hisblood
sugargraduallyincreased.
Theanswertothisistoavoidfattyfoodsandchoosehealthy,carbohydrate-
rich foods, letting the glycemic index help you choose the best of them (see
Chapter4).Thismeanslegumes(beans,peas,andlentils),vegetables,fruits,and
wholegrains.
Meals will always cause a temporary rise in blood glucose; what you are
looking for is an overall trend downward as your insulin sensitivity gradually
improves.
See your doctor. One common reason for rising blood glucose levels is
infection. A cold, a urinary tract infection, a foot sore, an ear infection—you
name it. They all tend to raise your blood glucose. Sometimes a surprisingly
small cut or a cough you’re hardly aware of boosts your fasting blood sugar
values. As the infection heals (with medical treatment as needed), your blood
glucosewillrecover.Yourdoctormaydecidetoadjustyourdiabetesmedications
intheinterim.
Check your stress level. Stress raises blood sugar. The fight-or-flight
response—the physical reactionthat gets you ready to fight orrun away from
danger—can kick in with any sort of threat, real or imagined. A rise in blood
sugar was much more useful when the threats we encountered were predators
andwarringtribes.Thatextrabloodsugarfueledthemusclesneededtorunor
fight. Today, we are more likely to be threatened by job worries, financial
difficulties,orrelationshipproblems,andrisingbloodsugardoesn’thelpduring
thosetimes.Butstressstillevokestheresponse,anditstillcausesabloodsugar
spike.
If stress is temporary, you will see your glucose spike resolve quickly. If
stressisongoing,gethelp.Meditation,yoga,andothertechniquescanhelpyou
dealwithstress.Iftheproblemisdeeper—ifyouareheadedintodepressionor
chronic anxiety—do not try to be a hero. See a qualified mental health
professionalandgetstartedwithatreatmentthatworksforyou.
Exercise.Ifyouaresedentary,nowisthetimetobringphysicalactivityinto
yourlife.Vigorousexercisehelpsreducebloodglucoselevels.SeeChapter11.
In most cases, these steps will help bring your blood sugar down. If it
remains high despite your best efforts, your doctor will want to adjust your
medications.
PERSISTENTHUNGER
Ifyouarecuttingbackoncaloriesinanefforttoloseweight,youmaybeleft
feelinghungry.OneofthereasonsIrecommendalow-fat,vegandietisthatitis
so substantial—it provides plenty of fiber to fill you up and has no limits on
portion sizes or calories. The result is weight loss without hunger. In our
researchstudies,weuseaquestionnairetomeasurehungeralongtheway,and
weconsistentlyfindthatthiswayofeatingleavespeoplefeelingsatisfied.
Whatifyourmealsdon’tquiteholdyou,though?Herearesomesuggestions,
startingwiththeobviousone.
Eatmore.Maybethatlittlebowlofoatmealisjustnotenough.Whenyou
arejustgettingto knownewfoods,it takesa littletimetofigureout theright
servingsizes.Youwillsoonsortthisout.
Go lowGI and highfiber. If you haveinstant oatmeal for breakfast, you
willgethungrysoonerthanifyouhavetheold-fashionedvariety.Thedifference
is simply that instant oats have had their fiber sliced up. Instead of flat rolled
oats,youhaveaboxfullofoatpowder.Thatmeansthattheycookquickerbut
alsothattheydigestquicker,spikeyourbloodsugarquicker(thatis,theyhavea
higherGI),andleaveyouhungryquicker.Eatingfoodsthatareinasnaturala
state aspossible prevents thatoverly rapid digestionand helps keep hungerat
bay.
YouwantfoodsthathavebothalowGIandhighfibercontent.Afoodthat
offersonedoesn’tnecessarilyhavetheother. Forexample, wholewheat bread
has lots of fiber, but something about the wheat grain causes it to release its
naturalsugarsintothebloodstreamratherquickly(i.e.,ithasahighGI).Infact,
whitebread(whichhashaditsfiberremoved)hasvirtuallythesameGIaswhole
wheat.Incontrast,ryebreaddigestsmoreslowly,releasingitsnaturalsugarsinto
the bloodstream more gradually, which means it has a low GI. To check your
fiberintake,doaQuickFiberCheck.
Havehealthysnacks.Therewillbemanytimeswhenyouwillwanttohave
abitetoeatbetweenmeals,andyoushould!SeeChapter5foradiscussionof
thebestchoices.
QUIETINGCRAVINGS
Ifyouhavehaddiabetesforanylengthoftime,youhavealreadybeencoping
withtheubiquitousnatureofjunkfood.Unhealthysnacksareeverywhere.But
why do they call to us as they do? Why is sugar or chocolate sometimes so
attractive?Whyischeeseormeatsometimeshardtoresist?Wheredocravings
comefrom?
One ofour research participantsonce asked me whatwas wrong withher.
She hadhad diabetes for12 years, and eventhough she knew thatshe should
stayawayfromsugaryfoods,shecravedthem.Especiallywhenshewasstressed
ortired,cookies,chocolate,andpastries seemedtocallhername. Shehad the
cravingsnearlyeveryday.“IthinkI’mjustaweak-willedperson,”shesaid.She
wasembarrassedabouthercravingsandfoundherselfavoidingthesubjectwhen
shespoketoherdietitian.
Hereisthemostimportantthingtounderstandaboutcravings:Theyarenot
causedbyweakwillorgluttony.Cravingsaretriggeredbybiologicalproperties
ofthefoodsthemselves.Thatis,certainfoodshavechemicalmakeupsthatcause
us tocrave them in verymuch the same waythat drugs, alcohol,and tobacco
haveaddictivecomponents.
Letmebeclear:Onlycertainfoodslendthemselvestocravings.Thesame
foodsarealluringtoalmosteveryone.
Fourtypesoffoodstriggerbiochemicaleffectsnotunlikethoseofaddictive
drugs. They are not as strong or as dangerous as drugs, but the chemistry of
addiction does seem to be at work with these foods. I have described these
effects in detail in a book called Breaking the Food Seduction. Here, I will
summarizethemainpointsyouneedtoknow.Thefourcategoriesofaddictive
foodaresugar,chocolate,cheese,andmeat.
Sugar.Sugarisnotsimplysweet.Inadditiontoitstaste,italsohasamild
druglikeeffect.Thatis,itaffectsthebraininessentiallythesamewayasopiate
drugs—morphine and heroin, for example—albeit not as strongly. This effect
helpsexplainwhypeoplecravesugar,especiallyduringtimesofstress.
Howdoweknowthatsugarhasthiseffect?Incontrolledstudies,researchers
useamedicationcallednaloxoneasaresearchtool.Nalox-oneisnormallyused
inemergencyroomstoblocktheeffectsofheroinorotheropiates.Ifaperson
hasoverdosedonheroin,doctorsinjectnaloxone,whichblockstheheroin(and
any other narcotic) from attaching to receptors in the brain. A comatose drug
addict, previously on the verge of death, rapidly awakens with a dose of
naloxone.
Researchers have given naloxone to volunteers and offered them various
sugaryfoods.Theythenmeasuredhowmuchthevolunteersateandcompared
theresultstothoseofthesametestdonewithoutnaloxone.
It turns out that naloxone causes a noticeable drop in sugar cravings.
Normally,youmightlongforaglazeddoughnutorpieceofpie,butwithadose
ofnaloxone,much oftheattractionis gone.Theeffectis particularlyclearfor
foodsthatcontainbothsugarandfat:cookies,cakes,andicecream.
Naloxoneisgivenintravenouslyandisnotatreatmentforfoodaddiction;it
isaresearchtool.Theseexperimentsshowthatsugardoesnotsimplydelightthe
tastebuds;italsostimulatesthereleaseofopiatechemicalsinthebrain.Justas
intenseexercise causesthe releaseofendorphins—natural feel-goodchemicals
withinthebrain—sugarseemstodosomethingverysimilar.
Letmebeclearaboutthis:Sugardoesnotcontainopiates.Rather,thetaste
ofsugaronthetongueiswhatapparentlytriggersthereleaseofopiateswithin
thebrain.Inturn,these opiatestriggerthe releaseof anothernaturalchemical,
calleddopamine,whichisthekeytothebrain’spleasurecenters.Drugsofabuse
—heroin, cocaine, marijuana, tobacco, alcohol, and all others—increase
dopamineactivityinthebrain.Sugarappearstodothesame.Evidencesuggests
thattheeffectsofsugaronthebraineasepainanddiscomfortandgiveusalittle
boost.Nowonderweturntosugaryfoods,especiallywhenwe’restressed.
Sugarhasthesameeffectsoninfantsjustafewhoursold.Whenbabieshave
a heel-stick to draw a blood sample, they cry noticeably less if a bit of sugar
waterisdribbledintotheirmouthfirst.
Sugarcravingsgo beyondplainsugar itself.Somepeople alsocravefoods
suchaswhitebreadorbagels,whichturntosugarrapidlyandreleasesugarinto
thebloodstream.Inessence,theycravehigh-GIfoods—sugar,cookies,crackers,
white bread, potatoes, or cold cereals. While we also enjoy low-GI foods, we
tendnottocravethem.
Chocolate. Chocolate’s addictive qualities have long been recognized in
psychiatric journals. And in scientific studies, the most ardent chocoholics’
desire falls away when they are treated with opiate-blocking drugs. These
experimentsshowthatitisnotsimplytasteormouthfeelthatkeepsushooked.
Chocolatealsoappearstohavemildeffectsonourbrains.
Chocolate’s attractionis not due simply to its sweetness.After all, no true
chocolate lover would be satisfied with sugar alone. Chocolate also contains
caffeine,theobromine,andphenylethylamine.Theseareallstimulants,andthey
mayplayaroleinchocolate’sseduction,asidefromitsopiateeffects.
If you are a chocolate lover, you probably already know that chocolate is
more than a food: You don’t just feel you want it, you feel you need it.
Regrettably, chocolate carries not only a load of sugar but also a considerable
loadoffat.
Cheese.Yes,itmaysmellabitlikeoldsocks,butcheeseisoneofthefoods
thatpeoplewhoaretryingtoimprovetheirdietshavethemosttroubleleaving
behind.Thereisobviouslysomethingbesidesfatandcholesterolincheesethat
accountsforitspopularity.
That “something” may be the dairy protein, or casein. Like all proteins,
casein’smolecularstructureislikealongstringofbeads,witheachbeadbeing
an amino acid. Normally, when proteins are digested, these amino acids come
apartonebyoneandareabsorbedintothebloodstreamtobeusedtobuildbody
tissuesandrepairanydamagetoyourbody.
Casein behaves differently. As it breaks apart, it does not simply release
individual amino acids. It breaks into short strings of amino acids—strings of
perhapsfour,five,orseven“beads.”Theyarenotjusttheaminoacidbuilding
blocks for protein; they are also biologically active compounds with a mild
narcoticaction.Scientistscallthemcasomorphins—casein-derivedmorphinelike
compounds.Ifscientistsweretofeedyoucheeseandthentakeasampleofyour
digestive tract contents, they would find an array of casomorphins with mild
narcoticactions.Somehavespeculatedthatthenarcoticeffectsofcasomorphins
are responsible for cheese’s attraction. These effects may also explain why
cheesecanbeconstipating,sincenarcoticcompoundsslowdigestion.
By now you know if cheese is your thing. If so, its fat and cholesterol
contentsareconspiringagainstyou.Shortly,wewilllookathowtokickthisand
otherfoodaddictions.
Meat. Men, in particular, often describe meat as the very last food they
wouldeverwanttogiveup.Nomatterhowoftentheyareremindedofwhatitis
doing totheir waistlineor cholesterol testresults, many have trouble breaking
theiremotionalattachmenttoroastbeef,steak,orchickenwings.
Onceagain,experimentswithopiate-blockingdrugssuggestthatpartofthe
desireformeatmayhaveitsbasisinopiateeffectswithinthebrain.Researchers
inEnglandgaveopiate-blockingdrugs tovolunteersandtestedtheirdesirefor
ham, salami, and tuna. The results showed that when the opiate effects were
blocked,volunteerslostmuchoftheirinterestinmeat.
1
RESETTINGYOURPRIORITIES
Ifcravingsare sabotagingyournewfood program,takeheart.You arenotthe
victimofabadupbringingoragluttonouspersonality.Thefactis,youarenot
attractedtojustanyfood,oreventomostfoods.Youmaylikeapples,oranges,
bananas,orasparagus,butyouhaveneveronceturnedtothemforsolaceduring
momentsofstress.Youhaveneverracedofftoaconveniencestorebecauseyou
just had to have cauliflower. You have turned to sugar, chocolate, cheese, or
meatbecausetheyhavechemicaleffectsonthebrain.Somebeverages,suchas
wine or coffee, also have druglike effects and can be addictive. But as far as
foodsgo,thosefouraretheonesthatworktheirunfortunatemagiconjustabout
everyone.
Before we see what you might eat instead of that sugary doughnut, candy
bar,orcheeseburger,let’stakeacloserlookatwhathappensinsideyourbrain
whenyoueatthesefoods.
Anetworkofcellsdeepinsidethebrainmakesupwhatissometimescalled
yourrewardcenter.Indeed,itisresponsibleforfeelingsofpleasure.Withoutit,
lifewouldbeonebiggrayday.
Therewardcenterisnottherejustforfun,however.Itistheretokeepyou
aliveandtomaintainthespecies.Hereiswhy:Ifyougotabsolutelynopleasure
fromeating,youmightforgetaboutfoodsentirely!Likewise,ifsexwereatotal
bore, the species would soon die out. Thus, when you eat or have sex, your
rewardcentergivesyoualittlebitofdopamineasakindofreward.
In the process, that dopamine release causes slight neurological changes,
changesthatputhigh-prioritystatusonrepeatingwhateveryouhavejustdone.
“That was fun,” your reward center seems to say. “Let’s be sure to do that
again.”
Innature,thiswouldmeangettingarewardforfindinganewfoodsourceor
a receptive mate, with the result that you would take advantage of your find
again and again. The problem is that this system is easily hijacked. Alcohol,
recreational drugs, tobacco—and yes, unhealthy foods—cause significant
dopamine release, so not only do you like them, you also want to have them
again and again. Your pleasure center rearranges your priorities to favor
whatever stimulated it most recently. You find yourself planning your day
aroundsugarorchocolate,justasanalcoholicmightregularlythinkaboutwhere
thenextdrinkiscomingfrom.Ifyouhaveeverwonderedwhytheseotherwise
banal foods have such sway, it is because they hijack your brain’s pleasure
circuitryandyourinternalpriority-settingsystem.
BreakingFree
Iftheoccasionaltasteofsugarorchocolateisreallynotabigpartofyourlife,
thereisnoneedtoworryaboutit.Butifyourwaistlineisexpandingbeforeyour
veryeyes,oryourhealthissufferingfromyourfoodhabits,itistimetowakeup
andsmelltheaddiction.Whatdoyoudoifyou’rehooked?
Thebestwaytodealwithunhealthyfoodsistoavoidteasingyourself.Set
themasidecompletely,atleastfornow.Donotkeeptheminthehouse,anddo
notbuythem.Thereisnoneedtoworryaboutwhetheryouwillreturntothem
inthefuture.Fornow,justleavethemalone.
In the process, your brain’s prioritiescan return to what really is good for
you.Youarelikelytofindthatyourdesireforunhealthyfoodsfadesthelonger
youareawayfromthem.Thefollowingstepswillalsohelp.
Eatahealthybreakfast,anddon’tskipmeals.Cravingskickinwhenyouare
hungry.
Getregularexercisesoyou’retiredenoughtosleepsoundly,andbesureto
getplentyofrest.Cravingsarestrongerwhenyouarenotsleepingwell.
Avoid situationsthat triggercravings. Somepeople findthat theircravings
are triggered by being alone, by television cooking shows, by concession
standsatmovietheaters,orbycertainfriendswhoarepreoccupiedwithfood
problems oftheir own. Try to identify yourtriggers and eliminatethem as
muchaspossible.
GettingtheTastewithouttheRegrets
Sometimes a simple substitution can help you steer away from an unhealthful
food.Hereareafew.
Ifyoucravesugar:Inrecipes,maplesyrup,molasses,sorghumsyrup,and
granulated sugarcane juice (Sucanat) can sometimes substitute for table sugar.
Thesearehardlyhealthfoods!Buttheideaistoreplacerefinedwhitesugarwith
asmalleramountofsyruporjuice.They’resoflavorfulyouwon’tnoticeyou’re
usingless.
SteviaisanintenselysweetderivativeofanherbfromParaguay.Itissoldas
a dietary supplement (its use as a commercial food additive has not yet been
approved).
Sucralose (Splenda) is a calorie-free sweetener made from cane sugar to
whichchlorinehasbeenchemicallyadded, greatlyincreasingthe sweetnessof
thefinalproduct.Sugaralcohols,suchasmannitol,sorbitol,andxylitol,arelow-
caloriesweetenerssometimesusedincandies,chewinggum,anddesserts.They
haveabouthalfthecaloriesoftablesugar.Thereare,ofcourse,otherartificial
sweeteners. The disadvantage of the lot of them is that they do not help you
break your love affair with sweets, so when artificial sweeteners are not
available,youwillfindyourselfreturningtosugar.
MyfriendandcolleagueHansDiehl,DrHSc,founderoftheCoronaryHealth
Improvementproject,says thebestthingtodo forasweet toothisto “haveit
pulled!”Theideaisthatifyousetsweetsaside,youwilleventuallyjustforget
aboutthem.
Of course, the best choices are fresh fruits—nature’s sweet foods. It also
helpstomakesureyourdiethasadequatecomplexcarbohydrate—grains,sweet
potatoes,andbeans,forexample.Thesefoodsprovidetheenergyyouneedina
formthatismuchmorehealthfulthansugar.
If you crave chocolate:Cocoa powderis essentiallydefatted chocolate. It
canbeusedinbeveragesandbakingorturnedintoadipforstrawberriesorother
freshfruit.Youcanalsofindlow-fatfrozenicecreamsubstitutesmadefromsoy,
aswellassorbets.
Ifyoucravecheese:gettoknownutritionalyeast.Soldinthesupplement
aisleofhealthfoodstores,nutritionalyeastflakes(notbrewersorbakersyeast)
addacheeselikeflavortosaucesandcasseroles.
In recipes, you can replace ricotta or cottage cheese with mashed, water-
packedtofumixedwithalittlelemonjuice.Ifyou’rechoosingsoycheeses,read
thelabel tocheck thefat contentand tosee whetherthey’re madewith added
casein,thedairyprotein.
If you crave meat:Good substitutesfor hotdogs, burgers,and delimeats
arenowwidely available.Seitan (madefrom wheat gluten),tofu, tempeh, and
texturedvegetableproteinareversatileproductsthatsubstitutewellformeatin
recipes. Surprisingly enough, the desire for meat fades very rapidly once it is
removedfromthediet.Peoplewhothoughttheycouldnotlivewithoutsteakor
asalmonfilletsoonfindtheyhaveabsolutelynodesireforit.
GeneticInfluencesonCravings
Althoughcravingscanaffectanyone,somepeoplemaybeespeciallyvulnerable.
Researchers have found that some people are born with fewer receptors for
dopamine, the brain chemical responsible for pleasurable feelings. Apparently,
thislackofreceptorsmeansthattheygetlessdopaminestimulationandlessof
thefeel-good sensationthat dopamineprovides. Thisleavesthem feelinga bit
outofsortscomparedwithotherpeople.Asaresult,theyaredrawntotobacco,
alcohol,or drugs; presumably, they areseeking thestimulation that naturehas
notgiventhem.Theymayevenfallpreytocompulsivegamblingorcompulsive
eating.
Itallstartswithagene.Thereceptorsfordopaminearebuiltaccordingtothe
specificationsonyourchromosomes—thelongspiralstaircase–shapedstringsof
genesineachofyourcellsthatdeterminewhoyouare.Yourmotherandfather
passed along their genes to you, and the makeup of your body reflects the
combinationofthetwo.Ifeitherparentpassedalongageneforhavingtoofew
dopamine receptors, you would have roughly one-third fewer receptors than
otherpeople.
If you were able to sample individuals in smoking cessation programs or
drugtreatmentclinics,youwouldfindthatasmanyas40percenthaveagene
that causes them to have too few receptors, called dopamine receptor D2, or
DRD2forshort.
Several years ago, I found myself wondering if people who have trouble
followingahealthfuldietmayhavethisgeneticvariation.ErnestNoble,MD,of
the University of California, Los Angeles, conducted genetic analyses on our
patients.Tooursurprise,wefoundthatnearlyhalfofourresearchparticipants
with type 2 diabetes hadthegene that was associated with fewer than normal
dopaminereceptors.Thatisfarhigherthantheroughlyone-in-fiveprevalencein
thegeneralpopulation.
This raised a disturbing question:Did the lack of dopamine receptors lead
themtoovereat?Didovereatingthenleadtoweightgain,whichinturntriggered
diabetes?Wehavenotyetsortedallthisout,butwedidfindthatwhilepeople
withthisgeneimprovedagreatdealonourdiet,theygotsomewhatlessbenefit
comparedto thosewith thenormal numberof dopaminereceptors.Their A1C
valuesdroppedbyabout0.9percentagepointonaverage,comparedtoadropof
1.6pointsforthosewithoutthegene.Atpresent,thistypeofgenetictestingis
done only in research studies. Your doctor cannot determine whether you are
geneticallyendowedwithfewerdopaminereceptors.Infact,asfarasyourfood
planisconcerned,itdoesnotmatter.Regardlessofyourgeneticmakeup,thediet
described in this book is very likely to help you. I raise the issue of genetics
simply to underscore the point that cravings and food addictions are physical,
notmoralissues.Theyareduetothepropertiesoffoodsthemselvesthatinteract
withournaturalbiochemistry.
One final point: If certain foods act like drugs, it pays to treat them like
drugs.Inotherwords,avoidthem.Justasitisharderforasmokertocutdown
than to quitand harder for an alcoholic to drinkwinemoderately than to quit
drinkingaltogether,itisverytoughtoteaseyourselfwithfoodsthathaveyouin
theirclutches.Itisactuallyeasierto leavethem alonecompletelyand doyour
besttoforgetaboutthem.Ifyouhavenothadoneofthesebiochemicallyactive
foods in a few weeks, you crave it much less than you would if you had it
yesterday.
Thebraincellatthetopcontainssmallpackets(vesicles)ofdopamine.Whenyouexperiencea
pleasurablesensation, these vesicles release their dopamine into the space (synapse) that lies
betweenthatcellandthenextone.Asthedopaminemoleculesreachthenextcell,theyattachto
its dopamine receptors, and their effect depends on how many dopamine receptors you have.
Somepeoplehaveapproximatelyone-thirdfewerreceptorsthanotherpeople.
DIGESTIVEPROBLEMS
Aplant-baseddietisgreatforpeoplewhohavebeenbotheredbyconstipation.
Itsnaturalfiberiswhatyourdigestivetractneeds.Somefoodscancauseabitof
gassiness,however.Ifyouexperiencethis,hereiswhattodoaboutit.
First,onlycertainfoodscausegas.Grains,fruits,andmostvegetablesgeta
not-guilty verdict. Beans and undercooked cruciferous vegetables (broccoli,
cabbage,cauliflower, andBrussels sprouts,for example)are themain culprits.
Chances are, all you need to do is have smaller servings. If you have been
replacingahugesteakwithahugeplateofbeans,rememberthatasmallamount
ofbeansgoesalongway.Trydownsizingyourportions.
Over time, you will find that your body adjusts, so you can have larger
portionswithlessgassiness.Ifyoucookbeansfromscratch,besuretodiscard
thewaterusedtosoakthemandthencooktheminfreshwater.Cookthemwell
(therearenoaldentebeans)!Thesamegoesforcruciferousvegetables.Yes,we
all love a stalk of fresh broccoli from the crudités tray, but if that gives you
digestivetrouble,cookvegetablesuntilyoucaneasilypiercethemwithafork.
Itgoeswithoutsayingthatyouwanttoavoiddairyproductsandsugar.Dairy
products, of course, are already off the list, but digestive problems are yet
anotherreasontosteerclearofthem,asyousawinChapter4.Thelactose(milk
sugar)thatmakesupfully55percentofthecaloriesinfat-freemilkcausesmany
peopletohavegas,cramps,anddiarrhea.Hereiswhy.
Duringinfancy,thelactaseenzymeisproducedwithinthebodyandbreaks
lactose apart in the baby’s intestinal tract so it can be absorbed and used for
energy.Aschildrenleaveinfancybehind,however,mostlosethisenzyme.The
result,lactoseintolerance,wasoncethoughttobeabnormal,butitisnowknown
tobethebiologicalnorm,notonlyforhumansbutforallmammals.Becausethe
body’s lactase production slacks off gradually, many people do not make the
connectionbetweentheirdigestivesymptomsandmilkproducts.
In about 85 percent of Caucasians, a genetic mutation causes the lactase
enzyme to persist well into adulthood. Even so, lactose intolerance will
eventuallyaffectmanyofthem,too.Deletingdairyproductsfromthemenufora
fewdayswillshowyouwhetheryouareamongthem.
Some adults have trouble digestingtable sugar (sucrose). Once again, it is
easy to check. Simply set it aside for a few days and see if your symptoms
improve.
HIGHTRIGLYCERIDES
Whenyourdoctorchecksyourcholesterol,triglycerideswillalsobelistedonthe
laboratoryreport. Triglycerides aremolecules of fatthat aretransportedin the
blood for various purposes. As with cholesterol, having a certain amount of
triglycerides in the blood is a normal part of human biochemistry. However,
whentriglyceridesarehigh,theyincreasetheriskofheartproblems,diseasesof
thepancreas,andotherproblems.AsyousawinChapter7,anormaltriglyceride
concentrationislessthan150mg/dl.Valuesof150to199mg/dlareconsidered
borderline, and values of 200 to 499 mg/dl are high. Concentrations of 500
mg/dlorhigherareconsideredveryhigh.
Some studies have suggested that diets high in refined carbohydrates may
causeatemporary risein triglycerides.High-fiberand low-GIfoods appear to
havetheoppositeeffect.
2
Youwillwanttomakeaspecialpointoffavoringthese
foods. In our research, a low-fat, low-GI, vegan diet brings down triglyceride
levelsveryeffectively.Inaddition,alow-fat,vegandiethelpsyouloseweight,
whichinturnreducestriglycerides.
Regular exercise helps, too. Moderate physical activity, such as walking,
lowers triglyceride concentrations. You will also benefit by avoiding alcohol.
Alcoholappearstoraisetriglyceridesslightly,sowhenyouavoidit,triglycerides
slidebackdown.
INTERACTIONBETWEENVEGETABLESANDPRESCRIPTION
BLOODTHINNERS
Warfarin (Coumadin) is a blood thinner prescribed to prevent heart attacks,
strokes,bloodclotsinthelegs,andotherproblems.Itactsbyantagonizingthe
effectsofvitaminK,whichisinvolvedinbuildingtheproteinsyourbodyusesin
theclottingprocess.
Many people taking warfarin believe they have to avoid vegetables,
especiallygreenleafyvegetables,thatarerichinvitaminKbecausethevitamin
willaffecttheirtendencytoformclots.Butavoidingthesehealthfulfoodswould
leavethemverylowinimportantvitaminsandminerals.
Iencourageyoutodiscussthisissuewithyourdoctorandyourdietitian,but
theanswerisnottoavoidvegetables.Whatmattersismaintainingafairlysteady
amount of them in your diet so your warfarin dosage does not need to be
continually adjusted. If you eat lots of healthy vegetables and then suddenly
stop,warfarin’sactionsbecomestronger,increasingtheriskofbleeding.Onthe
other hand, if you were to generally avoid vegetables and one day suddenly
increase your intake, the vitamin K in these foods would have the opposite
effect, making it easier for your body to form clots. Bottom line: Enjoy
vegetablesandkeeptheamountfairlyconstantfromdaytoday.
By the way, alcohol increases warfarin’s effects, which is why doctors
encourage people taking it to avoid alcohol. Many medications (e.g., aspirin,
acetaminophen,andmanyothers)canalsoaccentuatewarfarin’saction.
If you have hit any bumps in the road, I hope you have found these
suggestionshelpfulandthatyouarenowbackontrackwithahealthfuldiet.
CHAPTER10
WhichSupplementsShouldYouTake?
News stories and advertisements trumpet the benefits of various nutritional
supplements.Drugstoresandhealthfoodshopsarestockedwithshelfaftershelf
ofthem.Whichoneshelp,andwhichonesareunnecessary?
Here is some basic information that will help you decide. You should,
however, talk to your doctor, nurse practitioner, pharmacist, or dietitian about
whichproductsyoumaytake.Youmayhaveaparticularneedforoneoranother
supplement depending on your health. Or you may need to avoid certain
productsbecausetheyinterferewithmedicationsyouaretaking.
Ifyouareaddingsupplementsthatmightaffectyourbloodsugar,besureto
checkyourbloodglucoseregularly.RefertoChapter7forhowtorecognizeand
treatlowbloodsugar.
Let’slookatspecificvitaminsandothernutritionalcompounds,startingwith
thebasics.
Vitamin B
12
. This vitamin is essential for healthy blood cells and nerve
function.If you followa vegan diet,as Irecommend, you shouldtake adaily
vitaminB
12
supplement thatprovides atleast 5micrograms. Nearlyall brands
containmorethanthis,buthigherdosesarenottoxic.Manypeople,particularly
olderpeople, tendto runlowon vitaminB
12
regardless oftheirdiets, because
their bodies become less efficient at absorbing it. That is also true of people
takingmetforminoracid-blockingmedications.Yes,youcanfindvitaminB
12
in
somefortifiedproducts,suchasbreakfastcerealsandsoymilk,buttheamounts
maynotbeenoughtomeetyourneeds.
VitaminD.VitaminDisproducedwhenyourskinisexposedtosunlight.It
helpsyouabsorbcalcium,amongotherfunctions.Itisagoodideatospend15to
20 minutes daily outdoors. If you get this sun exposure, there is no need for
dietary supplementation. If you do not and also do not take a regular
multivitamin,a2,000IUvitaminDsupplementisagoodidea.
Asidefromthebasicvitamins,someothersupplementshaveshownpromise
forpeoplewithdiabetes.
Cinnamon. Cinnamon has been shown to improve blood sugar levels. As
little as ½ teaspoon of ordinary cinnamon added to your morning oatmeal or
other foods not only seems to reduce blood sugar, but also appears to reduce
bloodcholesterollevels.
1
Someofcinnamon’shelpfuleffectsmaybeexplained
by compounds called polyphenol polymers, which are found in the spice and
haveaninsulin-likeaction.
Magnesium. In harvard’s Nurses’ health Study, women who had more
magnesium in their diets had a significantly lower likelihood of developing
diabetes.
2
Apparently,magnesiumincreasesinsulinsensitivityandmayincrease
the secretion of insulin from the pancreas, which suggests that it may also be
helpfulafterdiabeteshasbeendiagnosed.
Thisdoesnotmean,however,thatyouneedamagnesiumsupplement.Foods
rich inmagnesium include whole grains(grains with their naturalfiberintact)
suchasbrownrice,barley,andoats,aswellasgreenvegetablessuchasspinach
andSwisschard.Manybeanvarietiesarealsorichinmagnesium.
Chromium.Chromiumisanelementthathelpsinsulinworkbetter,meaning
thatithelpsthehormoneescortglucosefromyourbloodstreamintoyourcells.
Technically speaking, chromium is what is called an insulin cofactor—an
insulinhelper,ifyouwill.Inthesamewaythatyoucannotuseajacktoliftyour
carifitshandleismissing,insulinhastroublebringingglucoseintocellswithout
chromiumtohelpitworkproperly.
Chromium’sessentialrolewasdiscoveredonlyrelativelyrecently.Inthelate
1960s, researchers found that chromium deficiency could lead to high blood
sugarlevels.
3
In1977,Canadian researchersdescribedthe caseof awomanin
her midthirties who was receiving all her nutrition intravenously following
intestinalsurgery. Astime wentby,shebegantoloseweight. Herblood sugar
startedtoriseinexplicably,andeventually,shedevelopednervesymptomsinher
legsthatappearedtobediabeticneuropathy.Herdoctorshadtoadministerlarge
insulindosestobringherbloodsugarundercontrol.Eventually,theygaveher
chromium, which had been absent from her feeding formula. In just a few
weeks,herbloodglucosefelltothepointwhereshenolongerrequiredinsulin,
andhernervesymptomsdisappeared.
4
Chromiumisnaturallypresentinmanyfoods,suchasbroccoli,greenbeans,
whole grains, nuts, and even coffee. Some experts recommend taking
supplementsaswell.
Whichfoodshaveit,andhowmuchdoweneed?AccordingtotheFoodand
NutritionBoardoftheInstituteofMedicine,thesafeandadequatedailyintakes
of chromium for adults ages 19 to 50 are 35 micrograms for men and 25
microgramsforwomen.Forpeopleover50,theamountsare30microgramsfor
men and 20 micrograms for women. Here is the amount of chromium in
commonfoods,aslistedbytheUSgovernment.
ChromiumContentofCommonFoods
FOOD PORTION CHROMIUM(MCG)
Broccoli ½cup,cooked 11
Grapejuice 1cup 8
Englishmuffin,wholewheat 1 4
Potatoes,mashed 1cup,cooked 3
Garlic,dried 1teaspoon 3
Basil,dried 1tablespoon 2
Orangejuice 1cup 2
Wholewheatbread 2slices 2
Redwine 5ounces 1–13
Apple,withskin 1medium 1
Banana 1medium 1
Greenbeans ½cup,cooked 1
Source: National Institutes of Health, http://ods.od.nih.gov/factsheets/Chromium_pf.asp#h2,
accessedApril10,2017.
Whileyouaremakingsuretoincludechromium-richfoodsinyourmenu,it
mayalso help tosteer clearof sugarand refined grainproducts such as white
flour.Thesefoodsarenotonlylowinchromium,theyalsoincreasechromium
loss from the body. Loss of the mineral is also increased by the stresses of
infection,strenuousexercise,andpregnancy.
Some researchers have gone beyond foods and have tested the effects of
supplements. However, studies in which researchers gave chromium to people
with type 1, type 2, or gestational diabetes have yielded mixed results. The
problemmaybethatsomestudiesweresmallandusedrathersmallchromium
doses,but some studiesusing higherdoses inindividualswith type2 diabetes
haveshownnobenefit.
5
Asaresult,mostdiabetesauthoritiesdonotrecommend
chromiumsupplements.
Ifyouaregoingtosupplement,youshouldbeawarethatthesafetyofhigh
chromium doseshas not beenas extensively studied asthat of otherminerals.
Studies using chromium for diabetes treatment often exceed the amounts
recommendedbytheUSgovernment,usingdosesofupto1,000microgramsper
day. Individuals with impaired liver or kidney function may be at risk for
adverse effects and should probably stay well below this level. The long-term
benefitsandrisksofchromiumsupplementationarenotknown.
Alpha-lipoic acid. Alpha-lipoic acid, sometimes called thioctic acid, is
naturally produced in the human body. It plays important roles in the
mitochondria, the microscopic “burners” that provide energy in the cells. It
worksasacofactorforseveralenzymesrelatedtoenergymetabolism.
Supplementalalpha-lipoicacidisusednottocounteractdeficienciesbutto
actessentiallylikeadrug.Inhighdoses,itactsasanantioxidant.Inpeoplewith
type2diabetes,itappearstoincreaseinsulinsensitivityandreducesymptomsof
nervedamage.
6,7
Inmanystudiesofalpha-lipoicacid,researchersusedintravenousinfusions
ratherthanoraldoses.Sofar,itappearstobesafe,butitisnotyetclearwhether
itwillyieldclinicallyimportanteffectsoverthelongrunandifso,whatdoses
aresafeandeffectiveforlong-termuse.
ForFurtherReference
If you search for information about supplements on the Web, you may find
yourselfcarriedawaybyafloodofcommercialsites.IrecommendthisNational
InstitutesofHealthsite,cc.nih.gov/ccc/supplements.
CHAPTER11
ExercisefortheRestofUs
Yes,exerciseisgoodforyou.Physicalactivityreducesyourbloodsugarandis
good for your heart. It improves the quality of your sleep and your overall
energylevel.Whenyougetintoanexercisegroove,youreallyfeelgreat.
Formanyofus,however,exerciseconjuresupimagesofpainfulworkouts
and unrewarding drudgery. Many people have trouble getting into an exercise
routine; it just does not seem to work for them. For every person I hear say
somethinglikethis:
“IfeelsogoodwhenIexercise.Ihavemoreenergy,mybloodsugar
comeswaydown,andIjustfeelgreat.Ican’timagineadaywithoutit.”
…there’sanotherwhofeelsmorelikethis:
“Ireallyjustcan’tgetintoexercise.IknowI’ddobetterifIdid,but
everytimeIjoinagymorresolvetostartexercising,itjustdoesn’tlast.”
If you are carrying around a lot of extra weight, exercise can be difficult.
Perhaps you are limited by joint pain or heart problems. Maybe your good
intentionsjustseemtovanishwhenthetimecomestolaceupyoursneakers.In
this chapter, we will tackle the various aspects of exercise—its benefits, its
limitations,andthedifficultiesingettingstarted—andseehowtomakeitwork
foryou.
One note of reassurance: If you cannot exercise because of a physical
limitation,youcanstillloseweight,cutyourbloodsugar,andliveahealthylife.
In fact, most of the benefits of the diet changes you have read about came
without exercise. That is because in our diet studies, we usually ask our
volunteersnottoaltertheirexercisepatterns,sowecanisolatetheeffectsofa
dietchangeforresearchpurposes.Exercisecertainlyaddstothehealthbenefits
thatagooddietbrings,butifitissimplynotinthepicture,youcanstilldowell.
WHATYOUAREWORKINGFOR
Differentkindsofexerciseprovideverydifferentbenefits.
Aerobicexercise is any sort of rhythmic, continuous activity you perform
for a sustained period—usually at least 10 minutes. Brisk walking, running,
playing tennis, dancing, or skating can all be aerobic. This type of exercise
reducesyourbloodsugarandtriglycerides,andifyoukeepitup,youwilllive
longer.
Resistance exercise is weight lifting and other exercises in which the
emphasis ison muscular effort: pushups and deepknee bends, for example.It
builds your muscle mass or at least preserves the muscle you have. It also
improvesinsulinsensitivity.
Flexibility exercises (stretching) are intended to maintain the range of
motionofyourjoints.Theycanalsorelievestress.
Below,Iwillgiveyouguidelinesforhowmuchandhowoftenyoushould
exercise.
Adiet–exercisecombinationcanhelppreventdiabetesfromeverdeveloping.
AgroundbreakingstudycalledtheDiabetesPreventionprogramfollowed3,234
people whose blood sugar levels were creeping upward but were not yet high
enough to warrant a diagnosis of diabetes. With a combination of diet and
exercise,theparticipantswereabletocuttheriskofdevelopingthediseaseby
58percent.Theexerciseregimentotaled150minutesperweek—ahalfhourfive
timesaweek.
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There is a very big caveat with all of this, though: Exercise can boost the
effectsofahealthydiet,butitcannotmakeupforapoorone.Infact,ofthetwo
components—diet and exercise—the diet portion is much more important for
weightlossandultimatelyforpreventingorcontrollingdiabetes.
A careful review of published research showed that people who begin
exercise programs do not lose much more weight than people who remain
sedentary.
2
Forweightcontrol,exercisecannottaketheplaceofdietchanges.
Thisdoesnotmeanthatexerciseisofnohelpatall.Itisdefinitelyhelpful
forreducingA1C.Inareviewofseveralstudiestestingtheeffectofexercise,the
average A1C in volunteers who began exercise programs fell to 7.7 percent,
whichisbetterthanthe8.3percentfoundinthosewhodidnotexercise.
3
Once
again,however,thatresultpalesincomparisontothebenefitsofadietchange.
To prevent diabetes or bring it under control, it is best to use both diet and
exercise.
onepartofyourbodythatbenefitstremendouslyfromexerciseisyourheart.
Arecentstudytrackedphysicalactivitylevelsinadultswithtype2diabetesover
aperiodof19yearsandlookedspecificallyattheriskofdyingofheartdisease.
It turned out that those who were moderately physically active were about 40
percentlesslikelytosuccumbtoheartdiseasethanweresedentarypeople.Their
routines included at least 4 hours per week of moderate exercise such as
walking,cycling,orlightgardening.
4
Activepeoplealsocuttheirriskofstroke.
5
There are three other exercise benefits worth noting. First, exercise and
eating are mutually exclusive activities. It is easy to scarf down extra calories
whilewatchingyourfavoritecrimedramaoramovie,butitisarealchallenge
whileyouareplayingtennis.Exerciseiscalorie-freefun.
Second, exercise helps you sleep. If you have given your muscles a good
workout,theydemandsleep.Youwillsleepmuchmoresoundlythanifyouhad
spenttheentiredaybehindyourdesk,watchingtelevision,orreading.Andwhen
youarewellrested,itiseasiertostayfocusedonahealthydietandsaynoto
unhealthfulfoods.
Third, exercise makes you feel better. It lifts your spirits and is a natural
antidepressant.
TYPEIANDTYPEIIMUSCLECELLS
Why do some people love exercise and others loathe it? Surprisingly enough,
partofthereasonisgenetic.Ifyoucouldlookinsideyourmusclesandcompare
them with those of other people, you would discover a sobering fact: Some
people were born to exercise. That is to say, their muscles naturally contain
manytypeIcells(thenamehasnothingtodowithtype1diabetes;itisjusta
coincidence).Thesemusclecellshaveaparticularlystrongbloodsupplymade
possiblebyarichnetworkofcapillariesthatbringinoxygenandreducefatigue.
They also have an extra supply of an enzyme called lipoprotein lipase, which
breaks fats apart to be used as fuel. The result is extra energy for a long run.
When you see people running down the road looking invigorated rather than
haggard,orwhensomeonewaxespoeticaboutthejoysoftherunnershigh,do
not envy their resolve. Odds are, they were born with muscles that are just
loadedwithtypeIcells.
Otherpeople’smusclescontainmostlytypeIIcells,whicharefineforshort
burstsofexercisebuthavelessenduranceforthelonghaul.
Now,havingsaidthat,itisimportanttorealizethatmusclescanchange,at
least to a degree. If you gradually but steadily increase the intensity of your
workouts(withinthelimitsofsafety),thebloodsupplytotypeIIcellsincreases.
Eventually,theybecomealmostasvigorousastypeIcells.
I raise this biological distinction to make an important point: Exercise
aptitude—orlackofit—isnotaquestionofcharacter;itisbiologyatwork.If
youhavebeenbeatingyourselfupforyourlackofathleticprowess,itistimefor
areprieve.
MAKINGITWORKFORYOU
Therearetwokeystomakingexercisework.
First,let’skeepitfun.Formostofus,thatmeansitshouldbeasocialevent.
Itismorefuntogowalkingwithsomeoneelsethanbyyourself.Ifyouplanto
exerciseatagym,youaremuchmorelikelytofollowthroughifyousignupfor
aclass—aerobics,yoga,orwhatever—thanifyougoitalone.Youarealsomuch
morelikelytoactuallygettoyourclassifsomeoneisgoingwithyou.
You might make an occasion of it and plan an especially healthful meal
afterward.Ifyouaregoingdancingorplayingtennis,thewordexercisemaynot
evenenteryourmind.Youractivityistooenjoyabletocallitthat.Keepitfun
becauseotherwise,youwillnotdoittwice,muchlessthreetimesaweek.And
formostpeople,funmeansfriends.Youneedotherpeoplewithyoutomakeit
work.
Second, it is important to exercise regularly rather than intermittently. To
paraphraseNewton’sfirstlawofmotion,“anobjectatresttendstostayatrest,
andanobjectinmotiontendstostayinmotion.”Iftheobjectatrestisyou—that
is,ifyouarefirmlyplantedonthecouch—youwilltendtostayatrest.If,onthe
otherhand,youandafriendgoforawalkeveryotherdayafterdinner,youwill
stayontrack.
Oneimportanttip:Asyouget readyfor anexercisesession,youwillhave
somemisgivings.Thelittledevilonyourshoulderwilltellyouthatyouaretoo
tired,youdon’thavetime,youjustdon’tfeellikeit,etc.Butthefactis,youwill
never feel like it right at that “getting ready” moment. So don’t wait for that
perfectdaywhenyouwill“feellikeit.”Justdoitanyway,anddoitnow.Geton
outthereanddoyourthing.Andverysoon,you’lldiscoverthatyouaregladyou
did.
Thiscyclewillrepeatitselfeverytimeyouexercise—feelingsofmisgivings
and negative thoughts, followed by your resolve to just ignore that negativity
anddoitanyway,followedbybeingsogladthatyoudid.Andbeforelong,your
confidencewillgrowandyou’llgetintoagroove.
Thereisanotherreasonforkeepingexerciseregular:Theeffectofanysingle
exercisesessionissmall.Ifyoubelongtoagym,youcanseethisforyourself.
Justjumponthenearesttreadmillandrunflatoutforamile.Then,asyoucatch
yourbreath,pushthelittlebuttonthatletsyouseehowmanycaloriesyouhave
burned. Surprised? That’s right, you have expended only about 100 calories.
That’s less than half the calories in an order of McDonald’s french fries or a
bottleofsoda.Asingleexercisesessioneverynowandthenwillnothelpyou
anymorethanoccasionallyeatingahealthymeal.Tobereallyeffective,healthy
habitshavetobepartofyourroutine.
Also,for better orworse, exercise effects donot last verylong. If youare
laid up with an injury, for example, you will find your blood sugar or weight
graduallyreturningtoitspre-exerciselevel.Peoplewhogetintoahabitofgoing
forabriskwalkorbicyclerideeverydayortwosustaintheirbenefits.
Bottomline:Tomakeexercisework,keepitfun,andkeepitregular.
SEEYOURDOCTORFIRST
Before you embark on a new exercise program, be sure to get your doctors
okay.Isyourheartuptoit?Areyourjointsready?Howvulnerableareyouto
hypo- or hyperglycemia? Do you have any special eye or foot problems that
could be aggravated by exercise? Your doctor should address all of these
questions.
Bewareofjumpingintovigorousexercisetooquickly.Ifithasbeenmonths
(oryears)sinceyoutriedexercisingregularly,startslowly.Ittakestimeforyour
body to reap the rewards of your new, improved diet. A heart patient, for
example,whobeginsavegandiet,stopssmoking,andstartsreallytakingcareof
himselfwillprobablyfeelbetterverysoon.Hischestpainmaymeltawaywithin
afewweeks,andhewillbeeagertojumpintoavigorousexerciseprogram.The
factis,though,thathestillhasthearteryblockageshehasbeenaccumulatingfor
years.Yes,thedamagecanbereversed,butittakestime,andheshouldnotpush
himselfpastthelimitssetbyhisdoctor.
If you have type 1 diabetes, you may find that your blood sugar drops
precipitouslyduringandafterexercise.Thiscanalsohappentopeoplewithtype
2diabeteswhouseinsulinordrugsthatcauseinsulinsecretion(e.g.,glyburide,
glipizide,glimepiride,nateglinide,orrepaglinide).Itisimportanttobealertto
thepossibilityofamajorbloodsugardropandtoadjustyoureatingschedule,
medicationuse,andexerciseaccordingly.
Occasionally,theoppositecanoccur:Youmayfindthatyourbloodsugaris
temporarilyhigherafterexercisethanitwasbefore.
AresearchteambasedinFloridatrackedbloodglucoseinchildrenwithtype
1diabetesastheywalkedonatreadmillinfour15-minutebouts,with5-minute
restperiodsinbetween.Theiraveragebloodglucosewas159mg/dlwhenthey
started,andit fellto 112 mg/dlafterward.At leastone-quarter of thechildren
became hypoglycemic during or right after the exercise. They were also more
likelytobehypoglycemicduringthefollowingnight.
6
Exercisecanreduceyourbloodsugarsurprisinglyquickly.Ofcourse,ifyou
eattoomuchinanefforttopreventhypoglycemia,yourbloodsugarcangotoo
high.
For these reasons, it is important to speak with your caregiver about your
medication,diet,andexerciseprogramtomakesureyouarereadyforexercise,
thenmakewhateveradjustmentsareneededforsafety.
GETTINGSTARTED
Okay. Your doctor has given you the green light, you have rustled up some
friends,andyouarereadytobegin.
If you were imagining that I would push you into hours of jogging and
weight lifting and harangue you with exhortations about “no pain, no gain”—
well,pushthosethoughtsaside.Thegoalistoenjoyexercise—somuchsothatit
becomespartofyourlife.
Foraerobicexercise,Isuggeststartingwithahalf-hourbriskwalk5daysa
week, assuming that you have no health-related exercise restrictions. If you
prefer,youcanexercisethreetimesperweek,eithertakingbrisk1-hourwalksor
doingmorevigoroushalf-hourworkouts.Youcanalsobreakupthose30-minute
walks into 10- or 15-minute mini-workouts if you like. Do not allow yourself
morethan2sedentarydaysinarow.Thebenefitsofwalkingarenotasgreatas
thoseofamorevigorousexerciseprogram,butitisagoodplacetostart.
Theimportantthingistofindatimethatworksforyou.
It is a good idea to put exercise on your schedule, as if it were an
appointmentwithyourself,andtoincludesomeoneelseinyourplans.
A pedometer will help you keep track of your progress. In our research
studies, we use an Omron pedometer to track the total number of steps
participantstakeeachdayaswellasthenumberof“aerobicsteps”(stepstaken
as partof acontinuous walk ofat least 10minutes). Theparticipants canalso
program in their stride length to track mileage and even estimate their calorie
burn.Takenoteofhowmany(orhowfew!)stepsyoutakeinanormalday,then
graduallyincreasethem.Forreference,10,000stepsormoreisavigorousday
for a healthy person, but you may not have the strength or stamina to do that
many.Donotpushbeyondyourdoctorsrecommendedlimits.
Apodiatristornursespecializingindiabetes(certifieddiabeteseducator,or
CDE)willhelpyoutakecareofyourfeet.Thisisimportantsinceexercisecan
sometimescausefootinjuriesoraggravateanexistinginjury.Itissurprisinghow
oftenpeopleareunawareofgraduallyworseningfootsores.
Yourdoctorwillhelpyougaugeyourimprovementandcanadviseyouabout
increasing your exercise intensity. As your endurance improves, you will find
that your energy just keeps increasing, and your weight and blood sugar stay
underbettercontrol.
What’sYourPleasure?
Takingaregularwalkisagreatwaytostartexercising.Whenyouarereadyto
addotheractivities,thinkaboutwhichonesyoumightenjoy.
Aerobicsclassescanbefun,social,andsometimesintense.
Dancingiswonderfulexercise,withbettermusicthanmostaerobicsclasses.
Tennis,eithersinglesordoubles,canbeagreatworkout.
Many health clubs organize racquetball or handball lessons and
competitions.
Golfcanbegreatexerciseifyouwalkthecourse.
Local running clubs often organize training groups for people working
toward5-K,10-K,andhalf-andfull-marathonraces.
For resistance and flexibility exercises, I suggest that you work with a
personaltrainer,bothforsafetyreasonsandtoindividualizeyourprogramusing
the rightequipment. Professional athletesare not theonly ones with accessto
professionalfitnessexpertise;youcanhaveit,too.Apersonaltrainercanhelp
youplanafullprogram,notonlyforaerobicsbutalsoforstrengthtrainingand
flexibility.
mosthealthclubshavetrainersonstaffandmayevenofferafreesessionas
anincentivetojoin.Whynottakeadvantageofit?Ifyoudonotplanonjoining
agym,justmakeanappointmentforasingleexercisecounselingsessionsoyou
cangetaprogramthatisrightforyou.Thenscheduleafollow-up.
NoBlame,NoShame
Withexercise,justaswithdiet,mostpeoplearenotyetwheretheywouldliketo
be.Guiltandblamecomeintothepicturewhenwearesedentary,justastheydo
when we are not eating well. Sometimes family members try to scold us into
exercising, and sometimes doctors try the same approach. But all their
moralizing is nothing compared to the guilt-laden punishment we heap on
ourselves,asifnotexercisingwereatremendousmoralfailing.
Ifthatiswhereyouare,letmeencourageyoutosetguiltandblameaside.
Justletitallgo.Tellyourguilt-inducingfriendsthatupuntilnow,youhavebeen
illustrating Newton’s first law of motion. Now, however, you are about to get
intogearandexplorethesecondpartofthatprinciple.
Thesameappliesifyouhappentofalloffthewagon.Let’ssayyouhavelet
yourexerciseregimenlapseforabit—maybeevenaverylongbit.Donotwaste
yourtimefeelingbadaboutit;ithappenstoeverybody.Justdustyourselfoffand
getbackon.
Whenexerciseisfunandyourfriendsorfamilyarepartofit—andwhenyou
startatalevelthat’srightforyouandkeepitregular—youhavetheformulafor
success.
PART3
CompleteHealth
CHAPTER12
AHealthyHeart
Managing or reversing the effects of diabetes means more than getting your
bloodsugarundercontrol.Italsomeansregainingyourhealthasmuchasyou
possiblycan,andsafeguardingit.
Ifyouhavebeeninpoorhealth—orifdiabeteshasattackedyourheart,eyes,
kidneys,andnerves—revampingyourdietcanhaveadramaticpositiveeffecton
yourwell-being.Inthischapterandthenext,wewilllookathowtokeepyour
heart—andtherestofyou—healthy.
TAKINGRISKSERIOUSLY
You probably already have a good idea of your risk of heart problems. Your
doctor has sized up your cholesterol level and blood pressure, and you know
your family history. You may be on medications to control cholesterol or
strengthenyourheart.
The next step is to review what you need to know about risks, and more
important, to see what you can do to prevent heart disease and, if necessary,
reversethediseaseprocess.
In evaluating your risk of developingheartproblems, doctors look at your
age, family history, smoking habits, weight, cholesterol level, blood pressure,
andotherfactors.Ibelieve,however,thatitisprudenttoactasifyouareatrisk
evenifnoneofthesefactorsapplytoyou.Hereiswhy:MostpeopleinNorth
AmericaandEuropehave alreadydevelopedarteryblockages—thebeginnings
of heart disease—by the time they reach early adulthood. Having diabetes
increasesthatrisk.Ratherthan wondering,“Am Iatrisk?”itissafe tosimply
assumethatyouare—andtotakeactiontoprotectyourself.
Some evidence suggests that your heart is assaulted especially hard by
smoking, high blood pressure, and high cholesterol levels, while your small
bloodvessels,suchasthoseinyoureyesandkidneys,areespeciallysensitiveto
highbloodglucoselevels.Thatisprobablytrue,althoughalloftheseriskfactors
matterforbothtypesofcomplications.
SIZINGUPTHEENEMY
let’s take a minute to understand the dragons we are slaying, starting with
cholesterol.
Yourbodyusescholesterolinthesamewayafactorymightusepetroleum.
Cholesterolisarawmaterial,andyourbodymakesmanythingsfromit.Believe
it or not, cholesterol is used to make certain hormones, including testosterone
andestrogen.Itisalsoinsertedintothethincellmembranesthatsurroundeach
cellinyourbody,anditactsasakindofgluetoholdthemembranestogether.
Withoutit,youwouldcollapseintoagelatinousheap.
Justasrefineriessendtrucksfilledwithpetroleumtofactoriestobeturned
into everything from plastic to petroleum jelly, your liver sends particles
containingcholesterolintoyourbloodstreamforyourcellstouse.
Imagine what would happen if a refinery flooded the roads with tankers,
sendingoutfarmoresupplythanwasneeded.Dayafterday,moreandmoreoil
truckswouldcloguptheroadways.Somemighthaveaccidents,spillingcargo
andcreatinghavoc.
Cholesterol presents the same problem. When too many particles of
cholesterol pass through your bloodstream, they create a different kind of
congestion.
The circulating particles can easily become damaged. When they do, they
sparkthe formation ofraised bumpscalled plaques,which are verymuch like
smallscarsonyourarterywalls.
Now, this is dangerous, because plaques are fragile. They can crack or
rupture,andwhenthathappens,thebloodaroundtheplaquestartstoclot.The
growingclotcanfillthearterylikeacorkandstopblood-flow.Ifthathappensin
anarterythatcarriesbloodtotheheart,aportionofheartmusclewilldie.That’s
aheartattack,whichdoctorscallamyocardialinfarction.
Thesolutiontotheproblemistoreducethenumberofcholesterolparticles
circulating in the bloodstream. Luckily, we know how to do that. Although
previousdiets had onlya modestability tolower cholesterol,the diet changes
describedwithinthepagesofthisbookaredramaticallyeffective.
IsItMyGenes?
Rickwas45whenhecametoourofficelookingforhelp.Hewasnotterriblyoptimisticthata
dietchangecouldreallyhelphim.Hisfatherhadhaddiabetesandheartdisease,andhisown
cholesterolhadbeenhighforyears.Previousdietshadlethimdown.Afewyearsearlier,his
doctorhadsuggestedlimitingredmeatandeatingmorefishandchicken,butthechangehad
hadnoperceptibleeffect.“Imusthaveageneticproblem,”hesaid.
Itmaywellbethatgenesplayedabigroleinhisproblem,Itoldhim.Butwewouldnotknow
that until we made a more serious effortto change his eating habits—one that went beyond
whathehadtriedbefore.
Iexplainedtohimwhatyouarereadinginthischapter.Hedecidedtogiveitatry.(Hisstory
continuesinthebox“JumpingIntoOatmeal.”)
REVERSINGHEARTDISEASE
Themostfamousprogramusingdietandlifestylechangestotacklecholesterol
andreverseheartdiseasewasdevelopedbyDeanornish,MD,atthePreventive
MedicineResearchInstituteinSausalito,California.
Dr.OrnishisaHarvard-trainedphysicianwhomademedicalhistoryin1990
byshowingthatacombinationofdietandotherlifestylechangescouldactually
reverse artery blockages. His findings were published in the Journal of the
AmericanMedicalAssociation,Lancet,andotherprestigiousjournals.
Inhis landmarkstudy,Dr. Ornishrecruitedheart patientsfromhospitalsin
the San Francisco area and divided them into two groups. Participants in one
group—the control group—were asked to follow their regular doctors’ advice
aboutdietandothertreatments.Generallyspeaking,thatmeantadietfavoring
chickenandfishratherthanredmeat,cuttingbackonfat,andusingmedications
asneeded.
The other group—the experimental group—was given a very different
regimen.Theydidnotusecholesterol-loweringdrugsatall.Instead,theybegan
averyspecialdiet.First,becausecholesterolisfoundinanimalproducts(meat,
dairy products, and eggs), Dr. Ornish chose a vegetarian diet for the study.
Remember, grains, beans, vegetables, fruits—in fact,all plant-derived foods—
areessentiallycholesterol-free.
Thesefoodsarealsofreeofanimalfat,whichisevenmoreimportant.Justto
clarify,cholesterolandfataretwodifferentthings.Cholesterolisamicroscopic
ingredient in cell membranes, as described above, and is present in all animal
cells.
Fatisdifferent.Itisthewhite stripina cutofroast beef,theyellow layer
under chicken skin, and the greasy residue left on your fingers if you touch a
salmonfillet.Youcaneasilyseeandfeelanimalfat.Whenyoueatit,yourbody
makescholesterol.
I learned about animal fat as a child growing up in North Dakota. Some
mornings,mymothercookedbaconformyfoursiblingsandme.Whenitwas
done,sheputthehotstripsonpapertowelstodrain.Shethencarefullypicked
upthefryingpanandpouredthehotgreaseintoajartosaveit.Now,shedidnot
storethejarofbacongreaseintherefrigerator;shesimplyputitinthecupboard.
Sheknew thatasitcooled, itwouldturn intoawaxy solid.Thenext day, she
spoonedsomeofthebacongreaseintoapanandfriedeggsinit.Withthatsort
ofdiet,itisperhapsremarkablethatanyofherchildrenlivedtoadulthood,but
thatisthewayweateuntilwelearnedbetter.
The fact that bacon grease is solid at room temperature is a sign that itis
loadedwithsaturatedfat,whichyoucanthinkofas“bad”fat,becauseitraises
yourcholesterollevel.
*
Allfatsaremixtures.Beeffat,forexample,isabouthalfsaturatedfat,with
the rest being a mixture of various unsaturated fats. Chicken fat is about 30
percent saturated fat. Fish vary from about 15 to 30 percent saturated fat.
Vegetable oils are much lower in saturated fat, except for the tropical oils:
Coconut,palm,andpalmkerneloilareallhighinsaturatedfat.
Some food companies alter vegetable oils through a process called
hydrogenation, which makes them similar to saturated fats. The resulting fats,
calledtrans fatsor partiallyhydrogenated fats,are solidand have along shelf
life. Unfortunately, their effect on your cholesterol level is similar to that of
butterorlard.Theyaresometimesusedinrestaurantfryersandinsnackfoods.
Whenyou seethewords partiallyhydrogenated vegetableoil on a food label,
it’sagoodideatomovealongtoahealthierchoice.
YoucanseewhyDr.Ornishdecidedtouseavegetariandietinaprogramof
healthy lifestyle changes. Plant foods have essentially no cholesterol and no
animalfat.Healsokeptvegetableoilstoaminimum.
The results were remarkable. Among the vegetarians, chest pain rapidly
melted away. The average person’s LDL (“bad”) cholesterol fell by about 40
percent. After a year, each participant had an angiogram—a special x-ray that
shows blockages in the arteries of the heart—and Dr. Ornish compared the
resultswiththoseofthesamekindoftestdoneatthebeginningofthestudy.The
resultswereamazing:Theblockages inthe coronaryarteries—thearteriesthat
nourish the heart muscle itself—were actually starting to shrink. The arteries
wereopeningagain.Theeffectwassopronouncedthatthedifferencecouldbe
clearlyseenontheangiogramsof82percentofpatientsafterthefirstyear—all
with no heart bypasses, no angioplasties, and not even cholesterol-lowering
drugs.
WAKEUPANDSMELLTHECHOLESTEROL
Bynowyouareprobablyyawning,sayingyoualreadyknowthatcholesteroland
saturatedfatarebadandthatwe’resupposedtocutdownonthem.“Beenthere,
donethat,”yousay.
Well,thatisexactlytheproblem.Foryears,healthauthoritieshavesuggested
that people “cut down” on foods containing cholesterol and animal fat. Many
peoplehavechosen“leaner”cutsofbeefandfavoredchickenandfish,butthey
havegottenverylittleinthewayofresults.Mostpeoplefindthatdespitethese
dietchanges,theircholesterollevelsbarelybudgeatall,andmanyhavedecided
that diet changes are a waste of time. They conclude that their problems are
geneticandgiveupontheirdiets.
It turns out that a switch from red meat to white meat is just not good
enough. And here’s why: All meats—even “lean” meats—contain cholesterol,
rangingfromabout10milligramsineveryounceoftunatoabout50milligrams
perounceofshrimp.Chickenandbeefareinbetween,withabout25milligrams
per ounce. And yes, cholesterol in foods does pass into your bloodstream.
Despite the egg industry’s efforts to convince scientists and the public that
“cholesterolinfoodsdoesnotaffecthowmuchcholesterolisinyourblood,”the
factis thatcholesterolinfoodsdoes indeedraise bloodcholesterol.Red meat,
poultry,andfish—eventhe“leaner”cuts—alsocontainasignificantamountof
fat.Andsaturatedfatcausesyourbodytomakecholesterol.
Incontrast,ofcourse,thereisnocholesteroloranimalfatinanyfoodfrom
plants.That goesfor everyfruit andvegetable; everybean; everygrain;every
varietyofrice,pasta,andpotato;andeverythingmadefromthem.
Thus,ifyouweretotrytoloweryourcholesterolbysimplyswitchingfrom
beef to chicken and fish, you would have one arm tied behind your back. As
showninclinicaltests,thecholesterol-loweringeffectofaswitchfromredmeat
towhitemeatisminimal—onlyabouthalftheeffectofaplant-baseddiet.Most
people who follow such diets have no measurable improvement within their
arteries,either—onaverage,theirarteryblockagescontinuetogetworseastime
goesby.
WHYDIDN’TANYONETELLME?
When Dr. Ornish’s findings were published, most medical authorities were
willingtobelievehisprogramwasaveryhealthfulregimen.Butmanyfeltthe
programwassoausterethatfewpeoplecouldactuallyfollowit.Ihavestudied
that issue in some detail, however, and have come to a completely different
conclusion.Thedietisnotterriblyaustere.Infact,itstacksupwellagainstany
otherdietadoctormightprescribe.Letmedescribemyownexperience.
When I was growing up in cattle country, my family ate pretty much the
samethingseveryday:roastbeef,bakedpotatoes,andcorn—exceptforspecial
occasions,whenweateroastbeef,bakedpotatoes,andpeas.
Inmedicalschool,Idecidedtochangemydiet.Atfirst,Itriedpasta,making
asaucefromfreshtomatoes,basil,andspices.ThenIdiscoveredthatjustbelow
the beef, poultry, and fish choices, Chinese restaurant menus feature many
deliciousvegetabledishes,asdoMexicanrestaurants.Japaneserestaurantsserve
delicious miso soup, salads, and vegetable sushi. Middle Eastern cuisine is
simplebutdelicious,withhummus,falafel,couscous,andotherdelights.Thai,
Indian,Ethiopian—allthesecuisinesofferendlessvegetarianchoices.Compared
tothoseelegantmeals,myNorthDakotaroastbeef,bakedpotato,andcornno
longerseemedlikethepinnacleoftheculinaryart.Tome,aplant-baseddietwas
aworldofnewtastesandwasanythingbutaustere.
WhenI firstlearned aboutthe workof Dr. Ornishin thelate 1980s,I was
workingatthepsychiatryclinicatGeorgeWashingtonUniversity.Itelephoned
him and suggested that we study the acceptability of his diet. I flew to San
Francisco and interviewed each of the participants in his heart study.
1
I asked
howwelltheylikedthefoodstheyate,howmucheffortwasrequiredtoprepare
them, whattheir family members thought,and what they planned todo in the
future.
Ifoundthatthevegetariangroupdidgrumbleabitatfirst.Theyhadtolearn
aboutsomenewfoodsandmastersomenewcookingtricks.Onaverage,ittook
about 4 weeks before the diet really became second nature to them. But they
adapted well, partly because they saw such dramatic results. Their cholesterol
levelsplummeted,theirchestpaindisappeared,andtheirheartdiseasereversed.
Theaverageparticipantlost,believeitornot,22poundsduringthefirstyear.
2,3
Theycametolovethefoodstheyate.
I vividly remember one participant’s reaction. He was angry—angry that
previousdoctors wereeagerto prescribepotentiallydangerousdrugs andeven
operateonhim,charginghimenormousamountsofmoney,anddidnotbotherto
evenmentionthepowerofdietchanges.Overall,theparticipantsnotonlyfound
theirdietsacceptable,theyfeltitwouldbewrongfordoctorsnottogivepatients
thiskindofchoice.
Now,itdidnotsurprisemethatthevegetariandiettookalittlegettingused
to,orthatthepatientssooncametoloveit.Whatsurprisedmewasthereaction
ofthecontrolgroup—thegroupthatwasnotaskedtoadoptthevegetariandiet.
They grumbled, too. Some said their diet was nothing but chicken and fish,
chicken and fish, chicken and fish, night after night. All the pleasures of life
were gone, some said. And they had nothing to show for it. Many were still
dealing with chest pain, trying to control their cholesterol levels with
medication,andfightingalosingbattle.
Having repeatedly studied how people react to different diets, I am
convinced that a vegan diet is actually easier to follow than most other diets.
Thisispartlybecauseofitssimplicity.Likequittingsmokingorfreeingyourself
fromanyotherhabit,settingasideunhealthyfoodsiseasierthanteasingyourself
withsmallamountsofthemdayafterday.Andthediet’sbenefitsareusuallyso
rewardingthatyouwanttostickwithit.
Afewyearslater,Ireviewedeverypublishedresearchstudyinwhichheart
patientswereaskedtochangetheirdiet,withresearcherstrackingtheirsuccess
orfailure.
4
Atthetime,theprevailingwisdomwasthatdoctorsshouldnotpush
theirpatientstoohardtomakedietchangesbecausethepatientswerelikelyto
justthrowuptheirhandsandgiveup.ButIfoundjusttheopposite.Incontrolled
studies,whenresearchersaskedpatientstomakesmalldietchanges,theyinfact
achieved only small changes. When researchers encouraged their study
participants to make bigger diet changes, most participants actually did make
them,andtheygotbetterresults.Youcandoit,too.Yourheartdeservesthevery
best.
AIMINGTOBEHEARTATTACK–PROOF
let’sleaveDr.Ornish’sCaliforniaresearchcenterandtakeashorttriptoOhioto
meetAnthonyYen.HegrewupinChina,wherehisfamilymembersroutinely
lived to a ripe old age. For them, heart disease, weight problems, diabetes,
cancer,andhighbloodpressurewerevirtuallyunheardof.Theydinedonrice,
noodles,andvegetabledishesofvariouskindsandusedmeatasnomorethana
flavoring,thewaysomemightusebitsofonion,garlic,orpinenuts.
In1949, asa youngman,Anthony movedto theUnitedStates andslowly
gaveuphistraditionalChinesedietinfavorofanAmericanone.Astheyears
wentby,hegraduallygainedweight,likemanyofhisAmericanfriends,andhe
started to develop heart problems, which steadily worsened. Ultimately, he
neededsurgery—aquintupleheartbypass.
Then he was lucky enough to join a program for heart patients run by a
surgeon at the Cleveland Clinic. Caldwell Esselstyn Jr., MD, aimed to get
cholesterol levels so low that heart disease would stop in its tracks. He
prescribed a vegetarian diet without dairy products or added oils. He showed
patientshowto cookandeven occasionallyhostedgroup dinnersthatfeatured
home-cookedfoods. Headded medicationsonlyif apatient’s cholesterol level
didnotfallbelow150mg/dlwithdietalone.
Theprogramworked.Dr.Esselstyn’spatientsbecamepracticallybulletproof.
Althoughtheywereinbadshapewhentheyarrived,noonewhoadheredtothe
program hadany sort of recurringheart problem.
5
Anthony’s cholesterol level
improveddramatically.Helostweightandfeltbetterthanhehadinyears.
Intheensuingyears,Dr.EsselstyncalledAmericancardiologiststogetherfor
theSummitonCholesterolandCoronaryDisease.Heputforwardhisbeliefthat
physiciansneedtopromotehealthierdiets.Ifdoctorscontinuetoprescribeonly
modestly effective diets, he said, their patients will be stuck with endless
prescriptions,operatingroomswillremainbusywithangioplastiesandcoronary
bypasssurgeries,andmedicalcostswillcontinuetosoar.
Dr.Esselstynwas right,asAnthony Yen, hisotherpatients,and agrowing
numberofphysicianscanattest.
SPECIAL-EFFECTFOODS
By now, you know which foods to avoid. By skipping animal products and
added oils, you will sidestep cholesterol and the fat that can drive cholesterol
levelsup.Ofcourse,youwanttoavoidthesefoodsanywayinordertoimprove
diabetes.
Therearefoodsyoumightwanttoaddtoyourdiet,though,becausetheycan
actuallyloweryourcholesterolorprotectagainstthedamagethatcholesterolcan
cause.
Oats, beans, and barley contain soluble fiber that reduces cholesterol
levels.Youhavenodoubtheardthatoatmealandotheroatcerealshavethis
effect, and they have become popular for exactly that reason. But do not
forget the cholesterol-lowering power of the humble bean, which also
containssolublefiber.Eatinga servingof beansevery daycuts cholesterol
levelssignificantly.Solublefiberisalsofoundinmanyvegetablesandfruits.
Soyproductshaveaspecialcholesterol-loweringeffect.Asidefromthefact
that they have no cholesterol or animal fat, there is something about soy
proteinthatbringsdowncholesterolabitfurther.Ifyourburgerismadeof
soybeansinstead ofbeef, youwillnot onlyskip beefs cholesteroland fat,
youwillalsogetanextracholesterol-loweringbenefit.
6
Certain nuts, such as almonds and walnuts, lower cholesterol, too. Yes,
they are as high in fat as other nuts, but somehow they have an ability to
reducecholesterollevelsthathasnotbeenfullyexplained.Instudies,eating
3 ounces a day for 4 weeks has shown a measurable effect.
7
I do not
recommendthatyoumakenutsaregularpartofyourdiet,however.Despite
theircholesterol-loweringeffect,theyaresofattythattheywillmakeweight
loss difficult and may interfere with your efforts to improve insulin
sensitivity.
Some margarines incorporate natural plant stanols or sterols that work
almost like drugs, blocking the absorption of cholesterol from the small
intestine.BenecolLightspread,forexample,containsplantstanolsderived
frompinetreesmixedintoaspreadmadewithcanolaandsoybeanoils(see
benecol.com).Youcanuseitinbakingandfryingifyoulike.Itisnotalow-
calorieor low-fat spread,though; 1 tablespoonhas about50 calories. Like
nuts,margarinescaninterferewithyourweight-lossefforts.
Fruitsandvegetablesarenotonlycholesterolfreeandverylowinfat;their
beta-carotene, vitamin C, and vitamin E can actually reduce the damaging
effectsofcholesterolinyourblood.Here’swhy.
Ascholesterolparticlesglidealonginyourbloodstream,thosethatenter
arterywallsandcauseplaquebuilduparetheonesthathavebecomeslightly
damaged, or oxidized. Beta-carotene, vitamin c, and vitamin E actually
protectthecholesterolparticlesfromdamagesotheygoontheirmerryway
withoutharmingyou.
Youwillfindhugeamountsofbeta-caroteneinorangevegetables,such
as carrots, sweet potatoes, and pumpkins, but there is also plenty in green
leafy vegetables. Vitamin C is in citrus fruits, of course, but also in many
other fruits and vegetables. And whole grains, vegetables, and beans are
healthfulsourcesofvitaminE.
At the University of Toronto, Dr. David Jenkins took this approach to its
ultimateconclusion.Hereasonedthatifavegandiet(thatis,onewithnomeat,
dairyproducts,oreggs)lowerscholesterollevels;ifsolublefiber,suchasthatin
oat bran, lowers cholesterol; if certain nuts lower cholesterol; if soy products
lowercholesterol;andifplantsterolslowercholesterol,thenwhatwouldhappen
ifheprescribedthemallatthesametime?
He devised what he called a portfolio Diet, which included all of these
elements, and found that the combination led to a 29.6 percent drop in LDL
cholesterol in just 4 weeks, which was similar to the effect of cholesterol-
loweringdrugs.
8
CONTROLLINGCHOLESTEROLSTEPBYSTEP
Let’ssummarizewhatresearchtellsusabouttheidealcholesterol-loweringdiet.
Herearethekeys.
1.Skipanimalproducts. Youwillwantto avoidmeat(thatmeansnored
meat, nochicken, and nofish),dairy products, andeggs. Avoid them entirely,
and you will eliminate all the animal fat and cholesterol from your diet. You
alreadyknowthisisimportantfordiabetes,anditisjustasimportantforyour
heart.
2.Keepvegetableoilstoaminimum.Totrimtheoilfromyourdiet,skip
theoilydressings,friedfoods,andfoodspreparedwithextraoil.Readthelabels
onpackagedfoods.Ifyouspotanimalproductsorpartiallyhydrogenatedoilsin
theingredientlist,youwillwanttoavoidthatfood.Andiftherearemorethan2
to3gramsoffatinaserving,skipit.
3. Add special-effect foods. The best of these are oats, beans, and soy
products.Theyarefillingbutmodestincalories,andtheyreallydobringyour
cholesteroldown.Itiseasytoaddspecial-effectfoodstoyourroutine.
Oats: Start your day with a bowl of old-fashioned oatmeal. Top it with
cinnamonifyoulike,butskipthemilkandsugarorusesoymilk.
Beans:Likeoats,beansarehighinsolublefiber,whichlowerscholesterol.
Bakedbeans,blackbeanswithsalsa,pintobeanswrappedinatortilla—all
are loaded with soluble fiber, protein, and all-around good nutrition. The
humblebeanhasevenbecomequitechic,withsomegrowersspecializingin
beautifullycolorfulheirloomvarieties.
Soy: It is easy to bring soy milk into your routine. You will also want to
learn about the many other forms of soy: low-fat tofu, tempeh, and many
others.Somepeopleareabittentativeabouttofuuntiltheytasteitproperly
prepared,thentheycometoloveit.Forallsoyproducts,readthelabelsand
choosethoselowestinfat.
Withthesechanges,mostpeoplecanexpecttoseemajorresults.Dietsthat
eliminatecholesterolandanimalfat(vegandiets),keepoilslow,andusespecial-
effectfoodstypicallyachieveabigreductionin“bad”cholesterol.
4. If you are overweight, follow the weight-loss guidelines described in
Chapter6.Eachpoundyoulosecutsyourtotalcholesterolslightly.
9
Theeffectis
gradualbutimportant.
5.Exercise.Whenyourdoctorgivesyouthegreenlighttoexercise,youwill
finditenormouslyhelpful.Exercisewillnotloweryourtotalcholesterol,butit
willincreaseHDLcholesterol,andthatmayimproveyouroverallhealthprofile.
Regularexercise(takingabrisk30-minutewalkfivetimesaweekora1-hour
walk three times a week) also helps keep your blood pressure under control.
Work with yourdoctor to set exercisegoalsbased on your current health(see
Chapter11).
JumpingIntoOatmeal
Rick,whomyoumetearlier,didverywellwithhisdietchangesdespitehisinitialreservations.
Helearnedhowtomakeaquickandheartyvegetablesoupfromadriedsoupmixtowhichhe
addedtomatoes,cucumbers,sweetpotatoes,andwhateverothervegetableshehadonhand.
Heoftencookedpastaandusuallyusedmarinarasaucefromajarforconvenience.Healso
includedplentyofsaladsandcookedvegetables.Eatingoutwasachallengeforhimuntilhe
discoveredthatinternational(Italian,Chinese,Japanese,Mexican,Thai,etc.)restaurantshad
plenty of options. Speaking up helped, too—most restaurants gladly made him a vegetable
platewhen he asked forit. He figured outwhich fast-food restaurants had veggie burgersor
saladbarsandwherehecouldgetarespectablebeanburrito.
Hetookashinetowhathecalledfakemeats—bologna,ham,andotherdelislicesmadeof
soy protein—which he used in sandwiches with sliced tomato, lettuce, and Dijon mustard.
Sometimeshehadasimplemealofbeansandriceorapackagedricedish(curriedrice,rice
pilaf, etc.). He also became quite fond of couscous. For breakfast, he jumped into oatmeal,
figurativelyspeaking,andkeptbananasandotherfruitsonhandbothathomeandatwork.
Whilehefoundthedietsurprisinglyeasy,heranintoastumblingblockatthebeginning.He
servedhimselfmodestportionsandresistedgoingbackforseconds.Asaresult,heoftenfelt
hungry.Thefix:Hesimplyatemore.Onanotheroccasion,hetookmyadvicetoeatbeansabit
toofarandhadanepisodeofgastricdistress.Hecutbackonhisbeanservingsizesforabit
andwasfine.
Hiswifejoinedhiminadoptingavegandiet.Intheprocess,shelostasubstantialamountof
weightandhadmoreenergythanshehadhadinyears.
BythetimeRickcameinforhisfollow-upbloodtest,hehadtotallyadaptedtothediet,and
hewasthrilledwiththeresults.In3months,hischolesterolhaddroppedfrom210to145,with
an LDLof well below 100. And this was the same man who had started out saying what he
reallyneededwasdifferentgenes.“Youknow,thisisn’tadiet,”hesaid.“Thisisawayofliving,
anditjustfeelsrighttome.I’mnevergoingbacktothewayIusedtoeat.Thisisit.”
SIZINGUPYOURPROGRESS
Itiseasytoseeiftheprogramisworking.Followitcarefully,andafterabout8
weeks, ask your doctor to check your cholesterol level. If you have not quite
reachedthegoalsyousetforyourself,takeacloselookatwhatyouhavebeen
eating. How well have you followed the program? If you really did follow it
carefully and your cholesterol failed to budge, you are probably one of those
uncommonindividualswhosegenesreallyaredrivinguptheircholesterollevels.
If diet alone proves insufficient, follow your doctors advice, which may
includecholesterol-loweringmedications.Somedoctorsbelievethatmedications
havevalueeven whencholesterollevelsarenormal. Researchisunder wayto
testthispossibility.
WHATABOUT“GOOD”CHOLESTEROL?
The cholesterol in high-density lipoprotein (HDL) particles is called “good”
cholesterolforonlyonereason:Itisonthewayoutofyourbody.HDLparticles
scour your artery walls, picking up cholesterol and eliminating it, like tiny
sanitationtruckscarryingawaygarbage.
When people begin low-fat vegan diets, their HDL levels sometimes fall
slightly.Butthatisnotareasontoworry—yourLDL(“bad”)cholesterollevelis
likely to fall much more. In fact, some people say that, since you have less
“garbage”inyourbloodstream(thatis,lessLDLcholesterol),youdon’tneedso
many“garbagetrucks”(thatis,HDLcholesterol)tohaulitaway.
REDUCINGTRIGLYCERIDES
Triglycerides is a technical term for fat in the bloodstream.
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lowering
triglyceridesis agood idea,as itwillreduce yourrisk ofheart problems.It is
usually easy to do. A low-fat plant-based diet is a good start. But take one
additionalstep:avoidsugar,whitebread products,and otherhigh-GI foods,as
discussed in Chapter4. These foods seem to raise triglycerides, while low-GI
foodsthatarerichinfiberseemtolowerthem.Youwillprobablyseeabigdrop
inyourtriglycerides.
ONESOLUTIONTOMANYPROBLEMS
If you have been following along, you have probably come to this happy
conclusion on your own: You do not need one diet for diabetes, another for
cholesterol control, and a third one for weight loss. A diet that skips animal
products,keepsvegetableoilslow,andfavorshigh-fiber,low-GIfoodstackles
alltheseproblemsatthesametime.
Justas a dropin cholesterolis goodfor yourheart, adrop in A1Cis, too.
Peoplewhokeeptheirglucoseundergoodcontrolhavefewerheartproblemsas
theyearsgoby.
Thesamedietchangesalsohelpcontrolyourbloodpressure,partlybecause
theycancauseyoutoloseweight,andasyourweightfalls,sodoesyourblood
pressure.Buttheeffectofvegetariandietsonbloodpressuregoesbeyondtheir
effectonweight.Plant-baseddietsarerichinpotassium,whichseemstoreduce
bloodpressure.Theabsenceofanimalfatalsoreducesbloodviscosity(thatis,
blood is less “thick”—less like grease and more like water) so it flows more
easilythroughthebloodvessels.
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For many people, the effect of diet changes rivals or exceeds that of
medications.If,forwhateverreason,yourcholesterol,bloodpressure,orblood
sugar doesnot come undergoodcontrol despite yourbest efforts,your doctor
willrightlytalkwithyouaboutmedicationstotakeupwheredietleavesoff.
*
Ifyouarewonderingwherethetermsaturatedfatcamefrom,it’sactuallyverylogical.Ifyoucouldlook
atafatmoleculeunderapowerfulmicroscope,itwouldlooklikealongchainofcarbonatoms,with
perhaps18or20atomsjoinedinaline.Attachedtothecarbonchainarehydrogenatoms.Ifthechainis
completelycovered(i.e.,saturated)withhydrogenatoms,thefatbecomesawaxysolidandiscalleda
saturatedfat.If,however,hydrogenatomsareabsentatseveralspotsonthefatchain,thefatiscalled
polyunsaturated.Polyunsaturatedoilsareliquids.Andifjustonespotonthecarbonchainhasnohydrogen
atomsattached,thefatiscalledmonounsaturated.Oliveandcanolaoilsarerichinthissortoffat.Theyare
unusualinthattheyareliquidatroomtemperaturebutsolidintherefrigerator.Saturatedfatisthekindthat
pushesyourcholesterolupward.
*
Thewordtriglycerideisderivedfromthefactthatwhenyourbodytransportsfatmoleculesfromone
placetoanother,itgenerallyattachesthreefatmoleculestoaglycerinemolecule(hence,tri-glyceride)
beforesendingthemintothewateryenvironmentofthebloodstream.
CHAPTER13
HealthyNerves,Eyes,andKidneys
Selwynwas 58years oldwhen heheard wewere lookingfor volunteersfor a
research study. Originallyfrom Trinidad, he hadbeen diagnosed withdiabetes
almost 20 years earlier. The disease had taken a toll on his eyes, and he was
beingtreatedforglaucoma.
Healsohadterriblenervepain.Inthe18monthsbeforethestudybegan,the
paininhisfeethadgottenworseandworse.“Itwasexcruciating,”hesaid.“It
hurtfrom the calvesdown, especiallyonthe leftside. And itworsened asthe
dayworeon.BythetimeIgothomefromwork,Ijusthadtoputmyfeetup.At
night,thebottomsofmyfeethurtterribly,withburningandtingling.”
He had had several medical tests to search for a treatable cause, but his
doctorswereleftwithonlydiabetestoblameforhismisery.Despitethefactthat
heusedinsulintwiceaday,hisdiabeteswasnotundergoodcontrol.
He began doing stretching exercises, which seemed to ease the pain
somewhat.Whenourstudybegan,hestartedalow-fat,vegandiet.Itsuitedhis
tastesandhadaremarkableeffectonhisdiabetes.Atthebeginningofthestudy,
hisA1cwas9.1percent,buthisbloodsugarbegantofallsoonafterhemadethe
switch to our eating plan. Within a month, he began to have episodes of low
blood sugar, so his insulin doses were reduced. Despite the fact that he was
takinglessmedication,hisA1Catthe3-monthpointwasdownto7.7.Thatwas
abigimprovement,althoughhewasnotyetwhereheneededtobe.
However,hekeptimproving.Andabout6monthsintothestudy,something
remarkablehappened.“Inoticedadrasticchange.Ihadbeenintotalpain,but
thesymptomsstartedgoingaway,”hesaid.As timewenton, thingsgot better
and better. The pain became barely perceptible, and eventually—to his
amazement—itdisappearedaltogether.“I’mtotallynormal,”hesaid.“Ihaveno
painatallanymore.”
If a medication could deliver the result he achieved, it would be a very
popularoneindeed.“Thedifferencehasbeenlikenightanddayforme,”hesaid.
Ahealthfuldietdoesmuchmorethankeepyourbloodsugardown;ithelps
protectyourwholebody.Ifdiabetesragesoutofcontrol,itcannotonlydamage
yourheart,itcanalsoattackyournerves,youreyes,andyourkidneys.Thediet
youarenowbeginningwillhelpyouavoidtheseproblems.Inthischapter,we
willlookathowtokeepallyourbodypartsingoodworkingorder.
HEALTHYNERVES
Peoplewithdiabetesareatriskofnervedamage,whichcantaketwoforms.
Peripheral neuropathy, sometimes called sensorimotor neuropathy, is
damagetothenervesthatallowyoutofeelthingsortomoveyourmuscles.It
leadstotingling,pain,numbness,orweaknessinyourfeetorhands.Itpaysto
takethesesignsseriouslybecausealthoughitcangetbetter,itcanalsogetalot
worseifyouarenotcareful.
Reducedsensationinyourfeetcanleaveyouvulnerabletoinjuriesthatyou
cannotfeel.Itiseasytooverlookasmallcutorscrapewhenyoudonotfeelit.
Injuriescanalsobeslowtoheal,whichcansetyouupforafesteringinfection.
Diabetesisacommoncauseofamputation,somethingthatshouldneverhappen
withgoodcare.
Autonomic neuropathy is abnormalities in the nerves that control your
internalfunctions.It canleadto digestiveproblems,suchasnausea,vomiting,
constipation, or diarrhea. It can also cause problems with bladder control or
sexual function. Other symptoms include dizziness, faintness, increased or
decreasedsweating,visualdifficulties(e.g.,problemsadjustingtolightanddark
conditions),andlackofawarenessofthewarningsignsoflowbloodsugar.
SEEYOURDOCTOR
Sometimes nerve symptoms have nothing to do with diabetes. If you have
unexplainednumbness,pain,tingling,orothernervesymptoms,itisimportant
tosee your doctorto check forconditions thatcan be treated.For example,if
you are low in vitamin B
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, you can have nerve pain that is indistinguishable
from the nerve symptoms of diabetes and can end up being permanent. Your
doctor willcheck your vitaminB
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bloodlevel and will helpyou get back on
track, if that is the issue. Nerves are also affected by thyroid conditions,
medications,infections,compression,andotherfactors.Soit’simportanttohave
agoodevaluation.
Ifthediagnosisisdiabeticneuropathy,thekeytopreventingandtreatingitis
to get your diabetes—particularly your blood glucose level—under control,
startingwithdietandexercise.Ifneuropathyhasaffectedyou,youwillwantto
rereadChapter4andfollowthedietguidelinestotheletter,aimingforthebest
possible glucose control under the guidance of your doctor. There are
medicationsthatcanhelpslightly,butformostpeople,dietandexercisearefar
morepowerful.
At California’s Weimar Institute of Health and Education, Milton Crane,
MD, asked 21 diabetes patients with peripheral neuropathy to do two things:
begin alow-fat, vegandietand takea daily 30-minutewalk. The effects were
rapidandverystrong:Within2weeks,legpainsstoppedcompletelyin17ofthe
participants,andtheremaining4hadpartialrelief.
1
Myownresearchteamcarriedthisresearchastepfurther.Weinvitedpeople
with neuropathy to see what a diet change alone could do for them—without
exercise.Notthat exerciseisbad.Just theopposite,it’svery healthful,butwe
wanted to isolate the effectof diet for scientific reasons, to see how powerful
foods could be. Using the diet steps that are now familiar to you (avoiding
animalproducts,minimizingtheuse ofoils,andfavoringlow-Glycemic-Index
foods), we found that, for many patients pain improved or simply went away,
andobjectivetestsofnervefunctionimproved,too.
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SupplementsforTreatingNeuropathy
Researchershave testedthe effectsof thefollowing supplements.The verdicts
arenotyetinonthemastreatmentsfornervedamage,soI’mlistingthemhere
notasarecommendationbutsimplytomakeyouawareofthem.
Alpha-lipoic acid appears to improve neuropathy symptoms.
3
In research
studies,adoseof600milligramstakenoncedailywaseffective.
Gamma-linolenic acid is an omega-6 fatty acid commonly sold in health
food stores. At doses of 480 milligrams per day, it appears to reduce
neuropathysymptoms.
4
Carnitine, in doses of 1,000 milligrams daily, appears to improve nerve
conditionandreducepaininpatientswithdiabeticneuropathy.
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IfYouHaveNerveDamage
Ifthenervesofyourfeethavebeendamaged,itisimportantthatyougetregular
checkupsandprotect yourfeet.Ifyou havelostsome feeling,check yourfeet
dailyforanysignofinjuryorinfection,suchasrednessorswelling,andhaveit
treatedrightaway.Avoidwalkingbarefoot.Ifyouhavelostsomefeelinginyour
feet,youmaynotknowifyousteponsomethingthatbreakstheskin.Besure
yourshoes fitproperlyto avoidblisters, andbreakin newshoes slowly. Keep
yournailsingoodshape,anddonottrimthemshorterthantheendsofyourtoes.
Ifyourvisionispoororyouhavedifficultysafelytrimmingyournails,havea
podiatristexamineyourfeetandtrimyournails.
Needless to say, you will want to focus on more than just caring for your
feet. Fight back against neuropathy with a healthy diet—vegan, low-fat, and
low-GI.
HEALTHYEYES
Youreyesaredelicatecamerasthatcapturetheworldaroundyou,transmitting
itsdetailstoyourbraintoperceiveandremember.Inthesamewaythatacamera
is fragile, several parts of the eye are susceptible to damage. This is true for
anyone, but especially for people with diabetes. Protecting your eyes means
keepingyourbloodglucose,bloodpressure,andcholesterolundercontrol.
Threepartsoftheeyeareparticularlyvulnerable.First,pressurecanbuildup
in the front part of the eye—called the anterior chamber—and eventually
damage the retina and optic nerve. This is glaucoma. Second, a cataract can
compromise the lens’s clarity. Third, blood vessels in the retina can become
damaged.Let’slookatwhatwecandotopreventthisthree-prongedassault.
Glaucoma
There are several different types of glaucoma. Typically, increasing pressure
withintheeyepinchesthetinybloodvesselsintheretina,damagingitandthe
opticnerve.Highbloodpressureandhighglucoselevelsbothincreaseyourrisk
ofdevelopingglaucoma.Yourbestdefenseistogetbothundercontrol,usingthe
informationinthischapterandtherestofthisbook.Ifglaucomaiscaughtearly,
treatment(withprescriptioneyedrops)ishighlyeffective.
Glaucomacanbeginwithnosymptomsatall,soitisimportanttohaveeye
examinationsbyanophthalmologistatleastonceayear.
Cataracts
Ifthelensoftheeyelosesitsclarity,becomingmorelikewaxedpaperthanlike
aclearpaneofglass,adoctordiagnosesacataract.Youmayexperienceblurred
ordoublevision, difficulty withdistancevision,a haloeffectaround lights,or
excessiveglareinbrightsunlightorwhiledrivingatnight.
Whilecataractsurgeryhas advanceddramaticallyinrecent years,theideal
situation is to keep your original equipment in good working order. Luckily,
thereareseveralthingsyoucandotohelppreventcataracts.
First, it is important to avoid tobacco and to protect your eyes from harsh
sunlight.
Second, it pays to follow the same diet steps that apply to controlling
diabetes in general, as described in Chapter 4. That means avoiding animal
products, keeping oils to a minimum, and favoring low-GI foods. There is
evidencethatthesestepsreduceyourrisk.Specifically,peoplewhoavoidfatty
foodstendtohavelesscataractrisk.
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Thesameappearstobetrueforpeoplewhoavoiddairyproducts.Generally
speaking,peoplewhosteerclearofdairyproductsappeartohavesignificantly
lessriskofdevelopingcataracts.
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Theculprithereappearstobelactose,ormilk
sugar,ratherthanmilkfat.
Duringthedigestiveprocess,lactosereleasesasimplesugarcalledgalactose,
whichcanenterthelens.Infantswholacktheenzymesnecessarytobreakdown
galactosedevelopcataractswithinthefirstyearoflife.Therelationshipbetween
dairy products and cataracts is still being studied, but this is one more good
reasontoavoidthem.
Certain foods help protect the eyes. Particularly valuable are green leafy
vegetables such as broccoli, spinach, kale, collards, and mustard greens. They
are rich sources of certain antioxidants, called lutein and zeaxanthin, which
protectboththelensandtheretina.
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FoodsrichinvitaminscandEmayhelp,
too.
9
You will find plenty of vitamin c in oranges, bell peppers, cantaloupe,
strawberries, and kiwifruit. It also shows up in places you may not expect:
cruciferous vegetables—broccoli, Brussels sprouts, cauliflower, and kale—as
well as tomatoes and sweet potatoes. Healthy sources of vitamin E include
cookedspinach,soy milk,mangoes, andwheatgerm. Mostnutsand seedsare
particularlyrichinvitaminE,butbecareful,astheyarefattyandloadedwith
calories.Asmallhandfulhasabout5milligramsofvitaminE.
Finally, people who avoid alcohol have about 10 percent less cataract risk
thanotherpeople.Evenverymodestconsumption,abouttwodrinksperweek,is
linkedtoincreasedrisk.
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Retinopathy
Theretina,locatedatthebackofyoureye,islikecamerafilm.Millionsoftiny
nervesintheretinapickupimagesandsendthemtothebrain.Alsolikefilm,
your retinas are fragile. They can be damaged by high blood sugar, blood
pressure, or cholesterol, leading to a condition called retinopathy, meaning
damagetotheretina.Theconditionoccursintwomainforms.
Nonproliferativeretinopathyoccurswhencapillariesballoonoutandleak
substances into the retina, leading to the formation of fatty deposits. The
condition is usually mild and needs no treatment, but it is essential that an
ophthalmologist check your eyes regularly to be sure that it does not become
moreserious.
Proliferativeretinopathy occurs when blood vessels are so damaged that
theybegintocloseoff.Whenthathappens,new,abnormalvesselsstarttoform
in the retina. The new vessels are fragile and prone to bleeding, leading to
scarringandsometimeseventoretinaldetachment.Ophthalmologistsuselaser
treatmentstotreattheabnormalvessels.
Most people with diabetes eventually develop at least a mild degree of
retinopathy. Thegoodnews isthatthere isa lotyoucan doto preventserious
problems.Goodbloodglucosecontrolprotectstheeyes,andbynowyouknow
how to go about attaining that. Keeping blood pressure and cholesterol down
helps,too.Thedietstepsabovewillgoalongwaytowardhelpingyoureachthat
goal.Ifdietaloneisinsufficient,yourdoctorwilladdmedicationsasneeded.
Retinopathy begins without symptoms, so it is essential to have your eyes
checkedregularlyandtochooseyourfoodsasifyourvisiondependedonit.It
does.
HEALTHYKIDNEYS
Yourkidneysaremadeupofmillionsoftinyfiltrationunits.Theypurifyyour
blood,sendingwasteproductsoutintotheurineandholdingontoproteinsand
othernormalbloodcomponents.Butjustastheretina’stinybloodvesselscanbe
damaged, so can the tiny vessels in your kidneys. High blood pressure, high
bloodglucose,andhighcholesterolassaultthem,leadingtoaconditiondoctors
callnephropathy.
left uncontrolled, kidney damage can progress to the point where your
optionsboildowntodialysisorkidneytransplant.Needlesstosay,youdonot
wantanythinglikethattohappen.Herearethedietstepsyouneedtotake.
First,followthebasicdietguidelinesfordiabetesasdescribedinChapter4.
The need is not just for avoiding fat and cholesterol and keeping your blood
glucoseandcholesteroldown,althoughthoseareveryimportant.Animalprotein
ispartoftheproblem,too,soyouwanttoavoidit.Sinceanimalproteintaxes
thekidneys,gettingyourproteinfromplantsourceshelpsprotectthem.
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This isan important point, so stickwith me while Iexplain:Many people
imaginethateggwhite,chickenbreast,orhaddockarehealthfulfoodsbecause
theyarehighinprotein—butthatveryfactiswhatmakesthemundesirable.The
lessanimalproteinyouconsume,theloweryourriskofkidneyproblems.You
aremuchsafergettingyourproteinfromplantsources—beans,vegetables,and
grains,forexample.
A low-fat, vegan diet is not only free of animal protein, cholesterol, and
animal fat, it also helps bring down high blood pressure,
12
which is also
importantforprotectingyourkidneys.
It goes without saying that you should avoid tobacco. Among its many ill
effects,smokingdamagesbloodvessels.
Ifyourbloodpressure,glucose,orcholesterolremainshighdespiteyourbest
efforts, yourdoctor will prescribe medicationsto bring it under control.Some
doctors prescribe medications even if your tests are in the normal range, as a
meansofprotectingkidneytissues.Thisisdoneonanindividualizedbasis.
Inarecentstudybyourresearchteam,wetrackedthekidneyhealthofour
participants.Theydutifullycollectedtheirurinetwiceovertwo24-hourperiods
so we could measure their albumin losses (your doctor will probably use less
arduoustests).Theydidthisbeforebeginningtheirassignednewdietsandagain
afterfollowingthemfor22weeks.
During this time, a group following a “conventional” diet that involved
limited calories and carbohydrates had a 21 percent average drop in albumin
losses.That’sachangeintherightdirection.However,agroupfollowingalow-
fatvegangrouphadtheadvantageofconsumingnoanimalprotein,animalfat,
orcholesterol,anditsaveragealbuminlosseswerereduced56percent,thatis,
theyfelltolessthanhalfoftheirbeginningvalues.
GETTINGHEALTHYANDSTAYINGTHATWAY
If you have been gaining weight, needing more and more medications, or
developingcomplications,mygoalistohelpyouchangecourse.Wenowknow
thatitispossibletoloseweighteffectivelyandpermanently,reduceoreliminate
medications, reverse heart disease, and even improve the symptoms of
neuropathy. If you thought you had to surrender to advancing symptoms, it’s
timetothinkagain.Youarenowinthedriversseat.
CHAPTER14
InformationforClinicians
Althoughthisbookisintendedasatoolforpeoplewithdiabetes,thereareafew
keypointsIwouldliketomentiontophysiciansandotherhealthcareproviders.
Asyouwillsee,thisprogramisbothveryeffectiveandhighlyengaging.While
healthcareprovidersareusedtoseeingtheirpatientsbecomingfrustratedwith
typical “diabetes diets” and requiring ever-higher medication dosages, both
physiciansandpatientsfindthisapproachfreshandrewarding.
Healthcareprovidersplaykeyrolesforindividualsonthisprogram,justas
theydowithanydiabetestreatmentprogram.Theyeducateandencouragetheir
patients,guidethemalongtheway,andmonitortheirprogress.
Intheresearchstudieswehaveconducted,wehavefoundthatmanypatients
treatedwithinsulinorinsulinsecretogogueshavehypoglycemicepisodesasthey
improvetheirdiets.Asyourpatientsembarkonthisnewdiet,youwillneedto
prepare them for that possibility and be ready to reduce their medications as
needed. It is also important that they understand that the hypoglycemia was
causedbythemedications,notbyanydefectintheirphysiology.Moreonthis
below.
THEROLEOFTHEHEALTHCAREPROVIDER
There are many ways physicians and other health care providers can help
patientsastheybeginmajordietarychanges.First,ofcourse,isencouragement.
Manypatients haveseen theirparents orgrandparents endup withfrightening
diabetes complications, such as eye problems, loss of kidney function, or
amputations, and many have already begun to experience neuropathy or other
problems by the time they decide to take the disease seriously. They need to
know thatthey can avoid these problems—asindeed they can—if theyfollow
youradvice,includingmaintainingagooddiet.
Itishelpfulforthemtoknowthatthisisnotthesamediabetesdiettheymay
havealreadytriedandthattheywillneedtolearnafewnewtricks.Theywill
discovernewproducts,newrestaurants,andperhapsnewmenuitemsattheirold
favoriterestaurants.Themosthelpfulphysicianslearnaboutthesedietchoices,
too.Ifyouhavenotyettriedalow-fat,vegandiet,Iwouldstronglyencourage
youtodoso.Apartfromitshealthbenefits,theexperiencewillalsoprepareyou
toanswerpatients’questionsandofferencouragement.
Onewaytohelppatientsgetstartedistoaskthemtotakeaweektotryout
healthfulveganfoods.Theideaisnottogiveupanything.Rather,theyarejust
tryingoutsomehealthfulbreakfasts,lunches,dinners,andsnacks.Inafewdays,
theywillhavefoundmanygoodideas(moreonthisinChapter5).
Then identify a limited period—say, 3 weeks—in which to give the diet a
goodtry.Fornow,thereisnoneedtocommittoitforever,butduringthisshort
period,they woulddo wellto followit 100percent sothey canexperience its
fulleffect.Oncetheyseehowitworks,theywillwanttocontinue.
Avoidthetemptationtowaterdownthediet.Clinicianswhotellpatientsto
followadiet“mostofthetime”orto“justdothebestyoucan”tacitlyencourage
themtodeviatefromit.Weneverdothatwhenpatientshavealcoholortobacco
problems,becauseweknowthatitiseasiertosticktoaconsistentprogramthan
totrytonegotiatewiththeseproblemsubstances.Thesameistrueoffood;itis
bettertoencouragepatientstogiveit100percent,neversettingafootwrong.
Occasionally, some patients will slip back into their old diet habits. When
thathappens,theywillalmostinstantlynoticethattheynolongermanagetheir
weightaswell,andtheirbloodglucoselevelswillstarttoclimbagain.Theywill
alsoarriveatyourofficewithaheavyburdenofguilt.Manywillspeakoffoods
as“sinful,”“decadent,”etc.Isuggestthatyouremainpositive,avoidmoralizing,
and return the focus to biology, which is where it belongs. Patients who have
returned fat to their diets may well be packing their cells with more
intramyocellular lipid, which is likely to harm their insulin sensitivity.
Encouragethemtodustthemselvesoffandgetbackonthewagon.
Somepatientsneedtobeencouragedtoeatcarbohydrate-richfoods.Because
ofthecarbohydratecountingtheyhavealreadylearned,theymayhavecometo
seeallcarbohydratesasunhealthful.Thisfeelingwasaidedandabettedbythe
never-endinglow-carbohydratedietcraze.Itisimportanttoremindpatientsthat
countries whose populations have traditionally consumed high-carbohydrate
diets—suchas Asiancountries, whererice andnoodles aredietarystaples and
meatanddairyconsumptionismuchlessprevalentthaninWesterncountries—
havehistoricallyhadverylowdiabetesrates.
You can also help patients ensure nutritional adequacy by asking them to
takeadailyB
12
supplement.Thisisgoodadviceforallpatients.
HYPOGLYCEMIA
Patients who are taking insulin or insulin secretogogues are subject to
hypoglycemia. When they improve their diets and begin to lose weight,
hypoglycemicepisodesarecommon.Inmyexperience,mostpatientsoninsulin
andabouthalfofallpatientsonasulfonylureawhobeginalow-fat,vegandiet
havehypoglycemicepisodes,usuallywithinthefirstseveralweeks.
Patients will be delighted to know that they have improved so much that
theirmedicationsarenowtoostrong,buttheywillalsobeconcernedaboutwhat
hypoglycemiameans.Itisimportantforthemtounderstandthatitwascaused
by their medication and that it does not indicate that there is anything wrong
withthem.Itisalsoessentialforthemtoknow,rightfromtheoutset,whattodo
and whom to call when these episodes happen. Of course, the initial steps—
checkingtheirbloodglucoseandtakingglucosetabletsorfood—arethingsthey
candoontheirown.Butitisimportanttoprovidespecificinstructionsandto
askpatients tocarryyour telephonenumber (orthatof anofficebackup)with
them and use it as necessary—even on weekends—so you can adjust their
medications. You will find my instructions for patients on dealing with
hypoglycemiainGlucoseTesting.
ADDITIONALRESOURCES
Registered dietitians, as you know, are indispensable allies in your work with
diabetes patients. Ideally, you will want to work with a dietitian who is a
certified diabetes educator and a member of the Academy of Nutrition and
Dietetics’ Vegetarian Nutrition Dietetic practice Group, which includes a large
numberofRDsskilledintheuseofvegetariandiets.
ThePhysiciansCommitteeforResponsibleMedicine(PCRM)providesfree,
noncommercialnutritioninformation,includingcontinuingmedicaleducationon
its Web site, PCRM.org, as well as guidance on how to begin low-fat, vegan
diets. It provides hundreds of recipes, shopping lists, and other user-friendly
information.Pleaseuseitandencourageyourpatientstodosoaswell.Theywill
especially like our 21-Day Vegan Kickstart, which offers 3 weeks of menus,
recipes,andcookingvideosinseverallanguages,allforfree.
Ifyouwouldliketojoin inour worktopromotehealthfuldietsand tackle
otherissuesinmedicineandresearch,IhopeyouwillconsiderjoiningPCRM.
Members receive our quarterly magazine, Good Medicine, and can sign up to
receive pCRM’s Breaking Medical News, a free, noncommercial service that
alertsyoubye-mailwhennewstudiesareabouttobreak.
MenusandRecipes
ThefollowingmenusandrecipesweredevelopedandtestedbyBryannaClark
Grogan, a veteran chef, recipe developer, and food writer. Originally from
California,BryannanowlivesinBritishColumbia.Hermanycookbookscover
anenormousrangeoffoodsandcookingstyles,fromquickandeasyrecipesto
manykindsofethniccuisine.
Bryanna’srecipesarefull-bodied,savorydisheswithaspecial“something.”
You will notice that their flavors go beyond the tastes and aromas of the
individualingredients.Theblendsofsimplefoodsandwell-chosenspicesmake
eachrecipespecial.
This recipe collection is intended for a wide range of tastes and
temperamentsandincludesbothsimpleandmoreadventurousofferings.When
we have included an unusual ingredient, you can find more information in
Appendix 2. Thanks to Gabrielle Turner-McGrievy, PhD, RD, and Jennifer
Reilly,RD,whocontributedadditionalrecipes.
HOWTOSTEAM-FRY
Some recipes call for steam-frying, a technique for sautéing or stir-frying
withoutfat.Hereishowtodoit.
Placeaheavynonstickskilletorstir-frypanovermediumheatandaddthe
ingredientstobecooked(e.g.,choppedonionsorothervegetables).Thenadd1
to 2 tablespoons of liquid (water, low-sodium vegetable broth, or wine)—just
enoughtokeepthefoodfromsticking.Donotcrowdthepan,orthevegetables
willstew.
Increasetheheattohighandcookuntiltheliquidstartstoevaporate,stirring
withawoodenspatulaorspoonuntilthevegetablesaredonetoyourliking.
You can brown onions perfectly by this method. As soon as the natural
sugarsin theonions starttobrown onthe bottomand edgesof thepan,add a
little more liquid and mix the browned portions with the remaining onions.
Continueuntiltheonionsaresoftandbrown,beingcarefulnottoscorchthem.
Tosteam-fryinamicrowave,useaglassdish,suchasaround10-inchpyrex
bakingdishorpieplate.Addtheingredients,includingthe1to2tablespoonsof
liquid,andcoverwithaglasslidormicrowaveableplate.Microwaveonhighfor
5 minutes or until the vegetables are soft, then add to the recipe. As almost
everyone with a microwave knows, you can cook vegetables in it, but you
cannotbrownthemoranyotherfood.Ifyoulikeabrown,crispytexture,stick
withthestovetopmethod.
7DaysofHealthfulMeals
DAY1
Breakfast
Oatmealcookedwithapples
Soymilk
Lunch
Black-EyedPeaandSweetPotatoSoup
Toastedryeorsprouted-grainbread
Spinachsaladwith mandarinorange segmentsandCreamyPoppySeed
Dressing
Snack
FruitSmoothie
Dinner
Lebanese-StyleLentilsandPasta
Steamedbroccoli
Orange-ApplesauceDateCake
DAY2
Breakfast
2High-ProteinOatWaffles
Slicedberries
Soyyogurt
Lunch
SpinachHummusandvegetablesofchoicewrappedinasprouted-wheat
tortilla
OrangeQuinoaandBulgurTabbouleh
Snack
Bakedcornchips,salsa,andVegetarian“Refried”Beans
Dinner
Indonesian-StyleStir-FriedPasta
Thai-StyleColeslaw
Freshfruit
DAY3
Breakfast
TofuScramblers
Ryetoast
Fruitsalad
Lunch
Paninisandwichmadewithsprouted-grainbread,TofuMayonnaise,low-
fatvegetariandelislices,andarugula
CreamyMushroomBisque
Snack
AppleslicesdippedinLemonCrème
Dinner
LemonandArtichokeTagine
OrangeCouscousPilaf
BabymixedgreenssaladwithCreamyBlackPepperDressing
BerryMousse
DAY4
Breakfast
BreakfastBarleywithFruit
Soymilk
Lunch
RedLentilandSweetPotatoSoup
ItalianStuffedGriddleDumplings
Snack
Rawvegetables
Wholegrainrye-crispcrackers
SpinachDip
Dinner
EggplantParmesan
GreensaladwithBalsamicVinaigrette
BulgurWheatandQuinoaPilaf
Freshfruit
DAY5
Breakfast
Frozenfat-freehashbrownsbakedinanonstickwaffleiron
Low-fatvegetariansausage
Slicedoranges
Lunch
BlackBeanSoftTacos
CherryTomatoandBrownRiceSaladwithArtichokeHearts
Snack
Orange-ApplesauceDateCake
Nondairymilk
Dinner
Balkan-StyleSlow-CookerStew
Crustyryebread
BrusselsSproutswithLemonandVegetarianBacon
Freshfruit
DAY6
Breakfast
MuesliCereal
Soymilk
Freshfruit
Lunch
SloppyJoesforTwoonsprouted-wheathamburgerbuns
Greensalad
Snack
Wholegraincrackers
CypriotYellowSplitPeaandDillSpread
Dinner
WhiteBeanandSweetPotatoStew
Sproutedgrainbuns
SautéedPortobelloMushroomSalad
Cranberry–Orange–PearGranolaCrisp
DAY7
Breakfast
WheatberryPancakeswithapple-cidermaplesyrup
Freshfruit
Lunch
BarleyandWinterSquashChowder
OatmealDropScones
RedCabbageSlawwithCranberriesandApples
Snack
PineappleSherbetPops
Dinner
VegetarianMixed-BeanChiliExpress
TenderBarleyCornbread
BLTSalad
Chocolate-DippedStrawberries
Breakfasts
BreakfastBarleywithFruit
Fordelicioustaste,lotsofsolublefiber,andawonderfullylowglycemicindex,
tryrolledbarley(alsocalledbarleyflakes)foryourbreakfastporridge.Ittakesa
bitlongertocookthanoatmealunlessyousoakitthenightbefore.Servewith
yourfavoritenondairymilkandatouchofbrownsugarorthesweetenerofyour
choice.
⅓cuprolledbarley(barleyflakes)
⅛teaspoonsalt
¾cupwater
1tablespoonwheatbran
½mediumapplewithpeel,coredandchopped,orotherchoppedfruit
1½teaspoonsgroundflaxseed
Thenightbefore:Combinethebarley,salt,andwaterinamicrowaveablebowl,
cover,andrefrigerateovernight.(Usea1-quartorlargerbowl—barleycanreally
boilup!)
Inthemorning:Addthebranandappleorotherfruittothesoakedbarley.Cover
the bowl with a microwaveable plate and microwave on high for 2 minutes.
Finishcookingonmediumfor4minutes.Stirintheflaxseed.
Tocookonthestovetop:Bringthesoakedbarley,bran,andappleorotherfruitto
aboilinasmallnonsticksaucepanoverhighheat,stirring.Reducetheheatto
low,partiallycover,andsimmerforabout15minutes,stirringoccasionally.The
mixture should have the consistency of cooked oatmeal. If it’s too watery,
continuecookingoverlowheattodesiredconsistency.
MAKES1SERVING
Perserving:197calories,6gprotein,8gcarbohydrates,8gsugar,2gtotalfat,
10%caloriesfromfat,0mgcholesterol,42gfiber,252mgsodium
TofuScramblers
It takesabout the sameamount of timeto make Tofu scramblersas it does to
makescrambledeggswhenyouusethehandyhomemademix.Shakeorstirthe
mixbeforemeasuring.Scramblerscanbeusedinbreakfastburritosorsofttacos
madewithsproutedwheatorcorntortillas,toppedwithsalsa,orusedinvegan
huevosrancheros.
ScramblerMix
1cupnutritionalyeastflakes
5tablespoons+1teaspoononionpowder
4teaspoonscurrypowder
4teaspoonssalt
4teaspoonsgroundturmeric
4teaspoonsgroundcumin
Scramblers
1½teaspoonsTofuscramblerMix
4ouncesreduced-fatextra-firmsilkentofu,crumbled
2tablespoonsreduced-fatsoymilk(optional)
Forthemix:Blendtheyeastflakes,onionpowder,currypowder,salt,turmeric,
andcumininadryblenderormini-processor.Storeinacoveredjar.
For the scramblers: Combine the scrambler mix and tofu well in a medium
bowl.Addthesoymilk,ifdesired.Cookthemixtureinaheavynonstickskillet
untilitreachesthedesiredconsistency,stirringconstantlywithaplasticspatula.
To microwave, combine the ingredients in a microwaveable dish, cover, and
cookonhigh(for4ounces,about2minutes;for8ounces,about3½minutes;for
12ounces,about5minutes;andfor16ounces,about7½minutes).
MAKES1SERVING
Perserving:54calories,9gprotein,3gcarbohydrates,1gsugar,1gtotalfat,
15%caloriesfromfat,0mgcholesterol,1gfiber,252mgsodium
Variations
If you like, add chopped vegetarian bacon or ham; vegetarian bacon bits; or
steam-friedchoppedonions,scallions,mushrooms,bellpeppers,ortomatoes.If
cookinginthemicrowave,placethevegetablesinthebottomofthedish,putthe
tofu(mixedwiththescramblermix)ontop,andcookasusual,thenstirtogether
beforeserving.
MuesliCereal
Bircher muesli was invented in Switzerland as a nutritious raw but digestible
breakfastcereal.Youcanbuyexpensivecommercialversions,buttheoriginalis
lowinfat,easytomake,andquick,aslongasyouremembertostartthenight
before.Servemuesliwithreduced-fatnondairymilkorsoyyogurt;brownsugar,
maplesyruporagavesyruptotaste;andfreshfruit(suchasberries),ifdesired.
1½cupsrolledoatsorotherrolledwholegraincereal
1½cupswater
2tablespoonswheatbran
2tablespoonscurrants,raisins,orotherdriedfruit
¼teaspoonsalt
2mediumappleswithpeel,grated
3tablespoonslemonjuice
The night before: Combine the oats and water in a bowl and refrigerate
overnight.
Just before serving: Add the bran, currants or raisins, salt, apples, and lemon
juicetothesoakedoats.
Note: To make 1 serving, use 6 tablespoons oats; 6 tablespoons water; 1
teaspoonbran;1teaspoondriedfruit;apinchofsalt;½smallapple,shredded;
and2¼teaspoonslemonjuice.
MAKES4SERVINGS
Perserving:173calories,6gprotein,36gcarbohydrates,11gsugar,2gtotal
fat,10%caloriesfromfat,0mgcholesterol,6gfiber,122mgsodium
OatmealDropScones
Traditional Scottish skon recipes contained no fat at all. They were eaten
immediately, warm and fresh, as these should be. Enjoy them with low-sugar
jam.
1cupold-fashionedoats
1¼cupswholewheatpastryflour(notregularwholewheatflour)
1teaspoonsugar
½teaspoonbakingsoda
½teaspoonsalt
1¼cupsreduced-fatsoymilk
1tablespoonlemonjuiceorvinegar
Sugarorcarawayseed
Preheattheovento400°F.Grindtheoatstoafinemealinadryblender.Pour
intoamediumbowlandaddtheflour,sugar,bakingsoda,andsalt.Mixwell.
Mixthesoymilkandlemonjuiceorvinegarinasmallbowl.Pourintothedry
mixture and stir briefly with a fork. Drop by large spoonfuls onto 2 nonstick
baking sheets (or baking sheets lined with parchment), making 12 mounds.
Smooththetopsabitwithwetfingertips.Bakeforabout15minutes.Splitwith
aforkwhilestillhot.
Forabannockshape:Dividethedoughinhalf.Withwethands,patthedough
pieces into 8" circles in two 9" nonstick cake pans (or cake pans lined with
parchment cut to fit). Score each circle into 6 wedges and bake for 15 to 20
minutes.
Sprinklewiththesugarorcarawayseed.
MAKES12SERVINGS
Perserving:77calories,3gprotein,15gcarbohydrates,1gsugar,1gtotalfat,
9%caloriesfromfat,0mgcholesterol,2gfiber,144mgsodium
Variations
CurrantScones:Add¼to½cupdriedcurrants.Youcanalsoadd¾cupgrated
apple.
HerbScones:Add½cuplooselypackedchoppedfreshherbsofyourchoice.
HerbBannock:Thisresemblesafocaccia,isquicktomake,andisagreatsnack.
Add½cupfreshherbstotheoatmealsconedough.Dividethedoughinhalfand
followtheinstructionsformakingthebannockshape.Makeindentationsallover
thedough with your fingertips. Spray the topslightly withwater from apump
sprayerandsprinklewithcoarsesaltorsoyParmesan,ortopwithsteam-fried
orgrilled choppedmushrooms, garlic, bellpeppers, and/oronions. Servewith
balsamicvinegarfordipping.
TenderBarleyCornbread
You can whip up this high-fiber, low-fat cornbread fast, and it bakes in 15
minutes.Usestone-groundcornmealifyoucan.
¾cupyellowcornmeal
½cupbarleyflour
⅓cupwholewheatflour(regularorpastryflour)
2tablespoonssugar
2teaspoonsbakingpowder
½teaspoonsalt
¼teaspoonbakingsoda
1cupreduced-fatsoymilk
¼cupunsweetenedapplesauce
Preheattheovento425°F.Whisktogetherthecornmeal,barleyandwholewheat
flours,sugar,bakingpowder,salt,andbakingsodainamediumbowl.Addthe
soy milk and applesauce and stir just until mixed. Scrape into an 8" × 8"
nonstick baking pan and smooth the top. Bake for 15 minutes. Cut the hot
cornbreadinto6equalpieces.
MAKES6SERVINGS
Perserving:150calories,4gprotein,32gcarbohydrates,5gsugar,1gtotal
fat,6%caloriesfromfat,0mgcholesterol,3gfiber,237mgsodium
High-ProteinOatWaffles
If you didn’t make these crisp, ultra-nutritious waffles yourself, you’d never
guessbeans wereamongtheingredients. Soakingthebeans takesjustminutes
before you retire for the night, and in the morning, you can make the batter
quicklyintheblender.(Note:Tocookwaffleswithoutaddedfat,youwillneeda
good-qualitynonstickwaffleiron.)
These waffles take a little longer to bake than ordinary waffles (about 8
minutes),soyoumaywanttomakethemaheadoftime.Theycanbereheated
quicklyinatoaster.Toppedwithchiliorcreamedvegetables,theymakeagreat
lunchorsupper.Forgluten-freewaffles,substitutebrownriceflakesorquinoa
flakesfortheoats.
½cupdriedcannellini,whitekidney,orgreatnorthernbeans
2¼cupswater
1¾cupsold-fashionedoats
2tablespoonssugaror1tablespoonagavenectar
¾tablespoonwholeflaxseed
1tablespoonbakingpowder
1½teaspoonsvanillaextract,or¾teaspoonvanillaextractand¾teaspoon
orange,almond,orcoconutextract
1teaspoonsalt
The night before: Place the beans in a large bowl and cover generously with
water.Refrigerateovernightorforuptoaweek.
Inthemorning:Drainthebeans,discardingthesoakingwater.Placeinablender
with2¼cupsfreshwaterandtheoats,nectar,flaxseed,bakingpowder,vanilla,
andsalt.Blenduntilsmooth,light,andfoamy.Setasideandpreheatanonstick
waffleiron.
Pouragenerous⅓cupofbatterontothehotwaffleironforeach4"waffle,close
theiron,andcookforaminimumof8minutes.Iftheironishardtoopen,letthe
wafflecookforanotherminuteortwo.
Repeatwiththeremainingbatter,blendingbrieflybeforepouringeachwaffle.If
thebatterthickens whilestanding,addenough watertoreturnit toitsoriginal
consistency.
The waffles should be golden brown and crisp. Serve immediately or cool
completelyonarackandfreezeinanairtightcontainer.Servewithyourfavorite
toppings.
MAKESTEN4"WAFFLES(5SERVINGS)
Perserving:196calories,10gprotein,35gcarbohydrates,2gsugar,3gtotal
fat,11%caloriesfromfat,0mgcholesterol,6gfiber,386mgsodium
WheatberryPancakes
Whowouldguessthatwiththehelpofyourblender,youcouldmakedeliciously
lightpancakesfromfreshlygroundwheatinminutes?Trythese!Leftoverbatter
worksgreatforwaffles,too.
1cupswheatberries(wholewheatkernels)
1tablespoonwholeflaxseed
2cupswater
⅓cupchickpeaflour(besan)orlow-fatsoyflour
1tablespoonsugar
2teaspoonslemonjuice
2teaspoonsbakingpowder
½teaspoonbakingsoda
½teaspoonsalt
Place the wheat berries, flaxseed, and water in a blender and process at high
speedforabout2minutes.Addtheflourandprocessfor2to3minutesoruntil
verysmooth.Addthesugar,lemonjuice,bakingpowder,bakingsoda,andsalt
andprocessuntilwellmixed.
Heataheavynonstickgriddleorskillet(anonstickelectricgriddlecooksvery
evenly)overhighheatuntildropsofwaterdanceonthesurfaceandthenquickly
disappear. Reduce the heat to medium-high. Working in batches if necessary,
pourdollopsofbatterquicklyontothegriddle,leavingspacetoexpand.When
bubbles appear on the surface, gently flip the pancakes. Don’t overcook; they
shouldbeabitpuffywhenyoutakethemoffthegriddle,sotheyarelightand
cakey.
MAKESTWELVE4"PANCAKES(3SERVINGS)
Perserving:261calories,11gprotein,53gcarbohydrates,6gsugar,3gtotal
fat,9%caloriesfromfat,0mgcholesterol,9gfiber,534mgsodium
FruitSmoothie
Thisquickandeasyrecipeisgreatwaytostartyourday—orgiveyouahealthy
boostanytime.
½cupunsweetenedappleororangejuice
½cupreduced-fatsoymilk
½cupfrozenblueberriesorotherberries
½cupfrozenpeaches
1tablespoonsoyproteinpowder
Combinethejuice,soymilk,berries,peaches,andproteinpowderinablender
orfoodprocessor.Blenduntilverysmooth.
MAKES1SERVING
Perserving:148calories,4gprotein,32gcarbohydrates,13gsugar,2gtotal
fat,9%caloriesfromfat,0mgcholesterol,3gfiber,65mgsodium
Dips,Spreads,andDressings
Low-FatGuacamole
This“mock-amole”iscreamyandtasty.Itisdeliciouswithbakedcorntortilla
chips.
5ouncesfreshgreenbeansorfrozensmallwholegreenbeans
5ouncesfrozenbabylimabeans
½cupreduced-fatfirmorextra-firmsilkentofu
3tablespoonslemonjuice
2clovesgarlic,crushed
¾teaspoonsalt
½teaspoongroundcumin
¼cupchunkyno-sugar-addedtomatosalsa
Cook the green beans and lima beans in enough water to cover for about 5
minutes or just until tender but not mushy. Drain well, transfer to a food
processor,andblenduntilsmooth.
Addthetofu,lemonjuice,garlic,salt,andcuminandblenduntilsmooth.Add
thesalsaandpulsebrieflytomix.Scoopintoacoveredbowlandrefrigerate.
MAKES2CUPS
Per¼cup:37calories,2gprotein,7gcarbohydrates,1gsugar,0.5gtotalfat,
5%caloriesfromfat,0mgcholesterol,2gfiber,226mgsodium
Vegetarian“Refried”Beans
Thisfat-freeversionofrefriedbeanshasalighttextureandcanbemadewitha
varietyofbeans.Italsomakesagreatwarmbeandiporadeliciouscoldspread
forsandwiches,wraps,orcrackers.
4½cupscookedor3cans(15ounceseach)black,smallred,kidney,orpinto
beans,rinsedanddrained
1smallonion,finelychopped
2tablespoonsredwinevinegar
1teaspoonsalt
1teaspoongroundcumin
1teaspoondriedoregano
1teaspoondriedgarlicgranules
1teaspoonchilipowder
Hot-peppersaucetotaste(optional)
Afewdashesofliquidsmoke(optional)
Place the beans, onion, vinegar, salt, cumin, oregano, garlic granules, chili
powder, hot-pepper sauce, if desired, and liquid smoke, if desired, in a food
processor.Blendforseveralminutesoruntilverysmooth.Transfertoaserving
bowl,cover,andrefrigerate.
Forahotdip,microwaveonhighforabout3minutesorheatinaskillet,stirring
constantly.
MAKES4CUPS
Per¼cup:68calories,4gprotein,12gcarbohydrates,0.5gsugar,0.5gtotal
fat,4%caloriesfromfat,0mgcholesterol,4gfiber,120mgsodium
SpinachHummus
Most versions of this popular Middle Eastern chickpea dip are chock-full of
olive oil and sesame tahini. This recipe contains a little tahini and plenty of
spinach or other greens for good nutrition and lots of color. Serve with raw
veggiesandwedgesofsprouted-wheatpitabreadorwithfat-freedarkrye-crisp
crackers.Heatingthechickpeasbeforeprocessingmakesacreamierhummus.
1package(10ounces)frozenspinach,thawed
2cupswell-cookedchickpeasor1can(19ounces)chickpeas,heatedand
drained
⅓cuplemonjuice
1tablespoonsesametahini
4–6clovesgarlic
1½teaspoonssalt
1teaspoongroundcumin
¼teaspooncayennepepper
Squeezeasmuchliquidfromthespinachasyoucanandchopwithasharpknife.
Setaside.
Place the chickpeas, lemon juice, tahini, garlic, salt, cumin, and cayenne in a
food processor. Blend until as smooth as desired, adding a bit of water if
necessary (it will thicken somewhat in the refrigerator). Add the spinach and
blendbriefly.
Transfertoaservingbowl,coverwithplasticwrap,andrefrigerateuntilreadyto
serve.
MAKESABOUT3½CUPS
Per¼cup:107calories,7gprotein,19gcarbohydrates,0.5gsugar,2gtotal
fat,13%caloriesfromfat,0mgcholesterol,6gfiber,336mgsodium
Variations
Trythisrecipewithcookedorthawedfrozenkale,Swisschard,orcollardgreens
insteadofspinach.
For a more traditional hummus, omit the greens and decrease the salt to 1
teaspoon,thecuminto½teaspoon,andthecayennetoapinch.
Fordelicious red pepperhummus,make thetraditionalhummus variationand
add½cupdrainedandrinsedroastedredpeppersfromajarwhenyouprocess
thechickpeas.
CypriotYellowSplitPeaandDillSpread
Thiseasyspreadisdeliciouswithdarkrye-crispcrackersorsprouted-wheatpita
wedges.Thegarlicmellowsconsiderablywhencooked.
1cupdriedyellowsplitpeas
7clovesgarlic
1smallonion,chopped
1teaspoonsalt
3cupswater
3tablespoonsfreshlemonjuice
2teaspoonsdrieddillweedor2tablespoonschoppedfreshdill
Freshlygroundblackpeppertotaste
Paprika(optional)
1sprigfreshdill(optional)
Combinethesplitpeas,6ofthegarliccloves,onion,salt,andwaterinamedium
saucepan.Bringtoaboil,skimmingoffanyfoam.Reducetheheat,cover,and
simmerfor30minutes.
Transfertoafoodprocessororblenderandprocess,oruseahand-heldblender
inthepan.(Removethe“pusher”fromthetopofthefoodprocessorsohotair
canescape.Covertheholelooselywithafoldedcleanclothwhileprocessing.)
crush the remaining garliccloveand add to the mixture along with the lemon
juiceanddill.Processuntilverysmooth.Seasonwiththepepper.
Pourintoadecorativeservingbowl,cover,andletcool.Garnishwiththepaprika
anddillsprig,ifdesired.
Thisspreadisbestservedatroomtemperature.Ifyoustoreitintherefrigerator,
simplybringittoroomtemperaturebeforeserving.
MAKES2½CUPS
Per¼cup:74calories,5gprotein,14gcarbohydrates,2gsugar,0.5gtotal
fat,2%caloriesfromfat,0mgcholesterol,5gfiber,193mgsodium
RedWineVinaigrette
This is a good basic dressing for many types of salads. Unlike plain juice or
water,theoilsubstitutewillhelpthedressingsticktothegreens.Iliketomake2
cupsatatimeandrefrigeratetheextra.
Fat-FreeoilSubstitute
1cupcoldwater
1tablespoonlow-sodiumvegetarianbrothpowder
2teaspoonscornstarch
Dressing
1¼cupsFat-FreeOilSubstitute
¼cupredwinevinegar
1tablespoonbalsamicvinegar
1clovegarlic,crushed
1teaspoonsalt
1tablespoonDijonmustard(optional)
1tablespoonbrownsugar(optional)
Fortheoilsubstitute:Placethewaterinasmallsaucepanandwhiskinthebroth
powder andcornstarch. Cook over medium-highheat, stirring constantly, until
thickenedandclear.
For the dressing: Whisk, shake, or blend the oil substitute, red wine and
balsamic vinegars, garlic, salt, mustard, if desired, and sugar, if desired, until
wellmixed.Transfertoajarandrefrigerate.
MAKES1½CUPS
Per2tablespoons:6calories,0.5gprotein,2gcarbohydrates,0gsugar,0g
totalfat,0%caloriesfromfat,0mgcholesterol,0.5gfiber,160mgsodium
Variation
BalsamicVinaigrette:Omittheredwinevinegaranduse5tablespoonsbalsamic
vinegar.Usetheoptionalmustardandbrownsugar.
Per2tablespoons:11calories,0.5gprotein,3gcarbohydrates,1gsugar,0.5g
totalfat,3%caloriesfromfat,0mgcholesterol,0.5gfiber,176mgsodium
SpinachDip
Serve this blender dip with raw vegetables and/or fat-free dark rye-crisp
crackers.
20ouncesreduced-fatextra-firmsilkentofu
¼cuplemonjuice
1envelopeLiptonRecipeSecretsVegetableSoupMix
½teaspoonsalt
1package(10ounces)frozenchoppedspinach,thawedandsqueezeddry
2scallions,minced
1can(8ounces)waterchestnuts,drainedandchopped(optional)
1tablespoonvegetarianbaconbits(optional)
Place the tofu, lemon juice, soup mix, and salt in a food processor and blend
untilsmooth.Addthespinach,scallions,waterchestnuts,ifdesired,andbacon
bits, if desired, and pulse until mixed. Transfer to a serving bowl, cover, and
refrigerateuntilreadytoserve.
MAKES4CUPS(12SERVINGS)
Perserving:16calories,1gprotein,3gcarbohydrates,1gsugar,0.5gtotal
fat,10%caloriesfromfat,0mgcholesterol,1gfiber,226mgsodium
CreamyPoppySeedDressing
This quickand easy dressingis very lowin fat. With just theright amount of
sweetness,it’sgreatonfruitsaladsandspinachsalads.
8ouncesreduced-fatfirmorextra-firmsilkentofu,crumbled
6ounces(½can)frozenapplejuiceconcentrate,thawed
6tablespoonsreduced-fatsoymilk
3tablespoonscidervinegar
1tablespoonpoppyseeds
1½tablespoonschoppedonion
1½tablespoonsdijonmustard
1scantteaspoonsalt
Placealltheingredientsinablenderandprocessuntilsmooth.Transfertoajar
andrefrigerate.Shakebeforeserving.
MAKES2CUPS
Per¼cup:45calories,3gprotein,7gcarbohydrates,1gsugar,1gtotalfat,
18%caloriesfromfat,0mgcholesterol,0.5gfiber,268mgsodium
CreamyBlackPepperDressing
Thisissuretobea favorite,especiallyifyou areafanofspinach salads.The
blenderisthekeytothecreamytexture.
1½tablespoonslow-sodiumvegetarianbrothpowder
1package(12.3ounces)reduced-fatfirmsilkentofu
1largeclovegarlic,finelychopped
3tablespoonsfreshlemonjuice
1tablespoonricevinegar
1tablespoonnutritionalyeastflakes
1½teaspoonswholeblackpeppercorns
1teaspoonmiso
1teaspoonsugar
¾teaspoonsalt
⅔cupwater
Placealltheingredientsinablenderandprocessuntilverysmooth.Transfertoa
jarandrefrigerate.Shakewellbeforeserving.
MAKES2CUPS
Per2tablespoons:15calories,2gprotein,2gcarbohydrates,0.5gsugar,0.5g
totalfat,11%caloriesfromfat,0mgcholesterol,0.5gfiber,123mgsodium
Soups
DutchGreenPeaSoup
A very satisfying meal on a cold day! Serve this soup hot along with dark
pumpernickelbread.
1cupgreensplitpeas
8cupslow-sodiumvegetarianbroth
1tablespoonvegetarianbaconbits
2mediumneworredpotatoes,peeledandchopped
2mediumleeks,chopped,includinganytendergreenparts
½cupchoppedcelery,includingleaves
½teaspoondriedsavory
½teaspoonliquidsmoke
1package(10–12ounces)low-fatvegetarianhotdogsorsausages,sliced
diagonallyintochunks
Salttotaste
Freshlygroundblackpeppertotaste
Bring the split peas, broth, and bacon bits to a boil in a large saucepan,
skimmingoffanyfoam.Reducetheheat,cover,andsimmerforabout3hours.
Addthepotatoes,leeks,celery,savory,liquidsmoke,andhotdogsorsausages.
Simmerfor30minutesoruntilthepotatoesaretender.Seasonwiththesaltand
pepper.
MAKES8SERVINGS
Perserving:184calories,15gprotein,27gcarbohydrates,3gsugar,3gtotal
fat,11%caloriesfromfat,0mgcholesterol,7gfiber,36mgsodium
BarleyandWinterSquashChowder
Thisisalovelysoupforacoldevening.
4cupslow-sodiumvegetarianbroth
1poundwintersquash,peeled,seeded,andcutinto¾"cubes
½largeonion,chopped
6ounceslow-fatchickensubstitutestrips,suchasButlerSoyCurls,
reconstituted
¾cuppearledbarley
8ouncesredpotatoes,chopped
¼cupchoppedceleryleavesandtops
1½teaspoonsvegetarianbaconbits
1bayleaf
½teaspoondriedthyme
½teaspoondriedsavory
1½cupsreduced-fatsoymilk
Salttotaste
Freshlygroundblackpeppertotaste
Choppedfreshparsley(optional)
Placethebroth,squash,onion,chickensubstitutestrips,barley,potatoes,celery,
baconbits,bayleaf,thyme,andsavoryinasouppotandbringtoaboil.Reduce
theheattolow,cover,andsimmerfor30minutes.Removethebayleaf,stirin
the soy milk, and season with the salt and pepper. Sprinkle each serving with
choppedparsley,ifdesired.
MAKES6SERVINGS
Perserving:204calories,11gprotein,40gcarbohydrates,4gsugar,1gtotal
fat,4%caloriesfromfat,0mgcholesterol,8gfiber,229mgsodium
CreamyMushroomBisque
A food processor turns this dairy-free soup into a rich, creamy treat with a
delightfulmushroomflavor.
1smallonion,finelychopped
5cupsmushroombroth
1bayleaf
½teaspoondriedthyme
⅔cupold-fashionedoats
12ouncesmushrooms,sliced
2teaspoonslow-sodiumsoysauce
2tablespoonsdrysherry(optional)
Salttotaste
Freshlygroundblackpeppertotaste
VeganParmesancheese(optional)
Steam-frytheonioninaheavynonstickskilletovermediumheatuntilsoftbut
notbrowned,addingverysmallamountsofwaterasneededtopreventsticking
andburning.(Orplaceinamicrowaveabledish,cover,andmicrowaveonhigh
for3minutes.)
Placethebroth,bayleaf,thyme,andoatsinamediumsaucepan.Addtheonion
and bring to a boil, then reduce the heat to low, cover, and simmer for 20
minutesoruntiltheoatsaresoft.
Meanwhile,steam-frythemushroomsinalarge,heavynonstickskilletoverhigh
heat, adding a sprinkle of salt and very small amounts of water as needed to
prevent sticking and burning. Cook until the mushrooms release and reabsorb
theirliquid.Removefromtheheatandsetaside.
Whentheoatsaresoft,removethebayleafandpureethesoupuntilcreamywith
ahand-heldblender orinbatchesin ablenderorfoodprocessor.(Removethe
middlepartoftheblenderorfoodprocessorslidsohotaircanescape.Cover
theholelooselywithafoldedcleanclothwhileblending.)
Return the soup to the pan and add the mushrooms, soy sauce, sherry (if
desired),salt,pepper,andveganParmesan(ifdesired).Servehot.
MAKES4SERVINGS
Perserving:80calories,5gprotein,14gcarbohydrates,3gsugar,1gtotalfat,
12%caloriesfromfat,0mgcholesterol,3gfiber,93mgsodium
Black-EyedPeaandSweetPotatoSoup
ThisdelectablesoupcontainsSoutherningredients—black-eyedpeas,vegetarian
baconandsausage,sweetpotatoes,andgreens.
1largeonion,chopped
3clovesgarlic,minced
6cupslow-sodiumvegetarianbroth
¼cuptomatopaste
3cupscookedor2cans(15ounceseach)black-eyedpeas,rinsedanddrained
2tablespoonsvegetarianbaconbitsorafewdashesofliquidsmoke
2teaspoonsdriedoregano
1bayleaf
½teaspoonsalt
½teaspooncrushedredpepper
4ounceskale,collards,orotherdarkgreens,cleaned,trimmed,andthinly
sliced
1poundsweetpotatoes,peeledandchopped
2vegetarianitaliansausages,suchasLightlifesmartLinksitalianorYves
VeggieSpicyItalianSausage,cutinto¼"slices
Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium
heatuntilsoft,addingverysmallamountsofwaterasneededtopreventsticking
andburning.(Orplaceinamicrowaveabledish,cover,andmicrowaveonhigh
for5minutes.)
Place the broth, tomato paste, black-eyed peas, bacon bits or liquid smoke,
oregano,bayleaf,salt,redpepper,greens,sweetpotatoes,andsausageinalarge
saucepan.Addtheonionandgarlicandsimmerfor30minutesoruntilthesweet
potatoesaretender.Removethebayleafandserveimmediately.
MAKES6SERVINGS
Perserving:257calories,16gprotein,44gcarbohydrates,8gsugar,3gtotal
fat,10%caloriesfromfat,0mgcholesterol,10gfiber,263mgsodium
RedLentilandSweetPotatoSoup
Thisheartysoupmakesagreatlightlunchorastarterforaseveral-coursemeal.
Blendinggivesitadelightfullysmoothtexture.
2smallonions,chopped
½teaspoongroundcumin
½teaspoongroundginger
4cupslow-sodiumvegetarianbroth
2cupscubedpeeledsweetpotatoes
⅔cupredorpinklentils,rinsed
1teaspoonlemonjuice
¼teaspoonsalt
Whitepeppertotaste
Paprika
Steam-frythe onionsin alarge,heavy nonstickskillet overmediumheatuntil
soft, adding very small amounts of water as needed to prevent sticking and
burning.(Orplaceinamicrowaveabledish,cover,andmicrowaveonhighfor5
minutes.)stirinthecuminandgingerandblendwell.
Place the broth, sweet potatoes, and lentils in a medium soup pot. Add the
onions and simmer, uncovered, for about 30 minutes or until the lentils are
tender.Addthelemonjuice, salt,andwhitepepper.Processusinga hand-held
blender in the pan or in batches in a blender or food processor, until creamy.
(Remove the middle part of the blender or food processor lid so hot air can
escape.Covertheholelooselywithafoldedcleanclothwhileblending.)Serve
hotandwithpaprikasprinkledontopofeachbowl.
MAKES4SERVINGS
Perserving:185calories,10gprotein,36gcarbohydrates,4gsugar,1gtotal
fat,3%caloriesfromfat,0mgcholesterol,6gfiber,158mgsodium
SandwichesandSalads
BlackBeanSoftTacos
InMexico,tacosareusuallymadewithfresh,hottortillas(notdeep-friedones).
Thismachine-blendedfillingbringsyouallthetraditionaltasteandheartinessof
therealthing.
TofuSourCream
1package(12.3ounces)reduced-fatextra-firmsilkentofu,crumbled
3tablespoonslemonjuice
½teaspoonsugar
¼teaspoonsalt
Tacos
8corntortillas(6")
1½cupsVegetarian“Refried”Beansmadewithblackbeans
2cups(1recipe)Low-FatGuacamole
1cupno-sugar-addedtomatosalsa
4cupsfinelyshreddedgreencabbageorlettuce
1cupTofusourcream
Forthe tofusour cream: Placethe tofu,lemon juice,sugar,and saltin afood
processor or blender and process until very smooth. Refrigerate in a covered
containerforupto1week.
Forthetacos:Heatthetortillas(seeNote).Spreadabout3tablespoonsofbeans
downthemiddleofeachtortilla.Topwithguacamole,salsa,cabbageorlettuce,
andtofusourcream.Eatoutofhandwithlotsofnapkins!
Note:Ifthetortillasarefrozen,heatthembetweentwomicrowaveableplateson
highforabout1minute,thenturnovertheplatesandheatfor1minutelonger.
Youcansoftenthawedorfreshtortillasinahot,drypan;grillthemquicklyjust
untilsoft;orwraptheminacleankitchentowelmoistenedwithhotwater,then
wraptheminfoilandplacethemintheovenuntilallareheated.Or,wrapthe
tortillasinacleankitchentowelmoistenedwithhotwater,wraptheminfoil,and
bakethemina350°Fovenforabout12minutes.
Ifyouhaveanoninsulatedmicrowaveablesteamer,placealittlehotwaterunder
the steamer tray. Wrap the thawed tortillas in a clean kitchen towel and place
theminthesteamertray.Coverandmicrowavefor2to3minutesfor6tortillas
or 4minutes for 12 tortillas.If you leavethewrapped tortillas inthe steamer,
theywillstayhotduringthemeal.
MAKES8SERVINGS
Perserving:174calories,10gprotein,33gcarbohydrates,3gsugar,1gtotal
fat,7%caloriesfromfat,0mgcholesterol,7gfiber,557mgsodium
AsparagusandVeggieHamPanini
ThisItalianpaniniwillbecomealunchtimefavorite.
2slicesryeorsprouted-grainbread
2tablespoonsTofuMayonnaise
6thinasparagusspears,steamedorroasted
6freshbasilleaves
2sliceslow-fatvegetarianbaconorham,suchasYvesVeggieCanadian
Bacon
Spread each bread slice on 1 side with 1 tablespoon tofu mayonnaise and
assemblethesandwichwiththerestoftheingredientsthewayyoulikeit,being
carefulnottooverfill.
Theeasiestwaytomakepaniniiswithanelectricnonstickpaninipressorclosed
indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as
goldenandcrispasyoulike,cookforafewminuteslonger.Cutthesandwich
intotrianglesandservehot.
Ifyoudonothaveapaninipressorgrill,cookthesandwichinaheavynonstick
skilletoronagriddleovermediumheat,placingaflatheavylidonthesandwich
asyoubrowneachside.
Perserving(usingrye bread):308calories,31g protein,32 g carbohydrates,
0.2gsugar,4gtotalfat,11%caloriesfromfat,0mgcholesterol,6gfiber,825
mgsodium
ItalianStuffedGriddleDumplings(Consum)
This traditional“griddle dumpling”from Romagna isactually a stuffed Italian
flatbread, similar to a calzone but stuffed with greens. This easy version uses
wholewheatpitas.
6wholewheatpitas
½poundSwisschard,beetgreens,spinach,orsavoycabbage,oramixture
½poundbittergreens,suchasarugula,radicchio,rapini,Chinesebroccoli,
mustardorturnipgreens,orcurlyendive
1½teaspoonschoppedgarlic
¼cuplow-sodiumvegetarianbroth
¼teaspoonsalt,andextratotaste
Freshlygroundblackpeppertotaste
Cutthepitasinhalfandopentoformapocket.Wash,trim,andthinlyslicethe
greens.
Placethegarlic,broth,greens,andsaltinalarge,deepnonstickskillet.Bringto
aboil,thencover,reducetheheattomedium,andcookuntiltender.Ifanyliquid
remains,uncoverandcookoverhighheat,stirringconstantly,untilitevaporates.
Seasonwiththesaltandpepperandsetasidetocool.
Drainthegreensandstuffinsidethepitahalves.Heatthefilledpitasonahot,
dry griddle or cast-iron pan over high heat, turning frequently, until hot and
fleckedwithbrownspots.Servehot.
MAKES6SERVINGS
Perserving:188calories,8gprotein,38gcarbohydrates,2gsugar,2gtotal
fat,8%caloriesfromfat,0mgcholesterol,6gfiber,510mgsodium
MediterraneanVeggiePanini
Italiansandwichmaking hasbecomeanart forminthenorthern cityofMilan
andhasspreadalloverEuropeandNorthAmerica.Sandwichbarsinitalyrange
fromhumbleplacestotheheightofsophistication,andsomeofferasmanyas30
varieties.
2slicesryeorsprouted-grainbread,suchasEzekielBread
2tablespoonsfat-freeitalianvinaigrettedressing
2jarredroastedredpeppers,rinsedandpatteddry
1cuptenderkaleleavesorothergreens
2smallfirm,ripetomatoes,sliced(freshRomatomatoesarebestbecausethey
arenotoverlyjuicy)
½cupslicedmarinatedartichokehearts,rinsed,drained,andpatteddry
Moisteneachbreadsliceon1sidewith1tablespoondressingandassemblethe
sandwichwiththerestoftheingredientsthewayyoulikeit,beingcarefulnotto
overfill.
Theeasiestwaytomakepaniniiswithanelectricnonstickpaninipressorclosed
indoor grill. Set the timer for 5 minutes, then check the bread. If it is not as
goldenandcrispasyoulike,cookforafewminuteslonger.Cutthesandwich
intotrianglesandservehot.
Ifyoudonothaveapaninipressorgrill,cookthesandwichinaheavynonstick
skilletoronagriddleovermediumheat,placingaflatheavylidonthesandwich
asyoubrowneachside.
MAKES1SERVING
Perserving (usingrye bread): 311 calories, 13g protein, 49g carbohydrates,
4.9gsugar,3gtotalfat,8%caloriesfromfat,0mgcholesterol,13.3gfiber,849
mgsodium
SloppyJoesforTwo
Here’satastyandhealthfulversionofanoldfavorite.
½smallonion,finelychopped
½smallgreenbellpepper,cored,seeded,andchopped
½smallredbellpepper,cored,seeded,andchopped
6mediummushrooms,chopped
¾cuplow-fatvegetarianhamburgercrumbles
½cupfat-freebarbecuesauce,suchasBull’s-EyeOriginal
1tablespoontomatopastedissolvedin½cuphotwater
2sprouted-wheathamburgerbuns,suchasAlvaradoStreetBakerybuns,split
andtoasted
Steam-frytheonions,peppers,andmushroomsinaheavynonstickskilletover
high heat until softened, adding water by the tablespoon as needed to prevent
stickingandburning.
Addthehamburgercrumbles,barbecuesauce,andtomatopastemixture.Cook,
stirring,untilthesauceisthedesiredconsistency.Spoonoverthesplitbunsor
fillthemlikeasandwich.
MAKES2SERVINGS
Perserving:218calories,14gprotein,40gcarbohydrates,11gsugar,2gtotal
fat,7%caloriesfromfat,0mgcholesterol,6gfiber,508mgsodium
OrangeQuinoaandBulgurTabbouleh
Thisisadeliciousandunusualversionofthewell-knownMiddleeasternsalad.
½cupmedium-grainbulgurwheat
1½cupswater
½cupquinoa
¾cupFat-FreeOilSubstitute
¼cuplemonjuice
1teaspoonsalt
1teaspoongroundcoriander
2pinchesgroundcinnamon
Freshlygroundblackpeppertotaste
2cupschoppedfreshparsley
1cupcookedorcannedblack-eyedpeas,rinsedanddrained
⅔cupchopped,seededgreenbellpepper
½cupchoppedfreshmintorlemonbalm
½cupchoppedscallion
Gratedpeelof2oranges
4jarredroastedredpeppers,rinsedandchopped
Orangewedges(optional)
Mint,parsley,orlemonbalmsprigs(optional)
Soakthebulgurin½cupboilingwaterinalargebowl,covered,for30minutes.
Meanwhile, bring the quinoa and 1 cup water to a boil in a small saucepan.
Reducetheheattolow,cover,andcookfor15minutes.Removefromtheheat
andletstanduntilthebulgurisready.
Whisk or blend together the oil substitute, lemon juice, salt, coriander,
cinnamon,andblackpepperinasmallbowl.Setaside.
Combine the quinoa with the bulgur. Add the parsley, black-eyed peas, bell
pepper,mintorlemonbalm,scallion,orangepeel,redpeppers,andoildressing
andmixwell.Garnishwithorangewedgesandsprigsofmint,parsley,orlemon
balm,if desired. Refrigerate,but letstand atroom temperaturefor 30 minutes
beforeserving.
MAKES8SERVINGS
Perserving:136calories,5gprotein,29gcarbohydrates,2gsugar,1gtotal
fat,7%caloriesfromfat,0mgcholesterol,7gfiber,303mgsodium
CherryTomatoandBrownRiceSaladwithArtichokeHearts
This delicious salad is a complete meal and a great picnic or potluck dish.
Becauseneithertomatoesnorricebenefitfromrefrigeration,itshouldbeserved
atroomtemperature.
3cupscookedbrownbasmatirice,warm
6ouncesmarinatedartichokehearts,rinsedinhotwater,drained,andsliced
1cupchoppedscallions
1½poundsred,yellow,ormixedcherrytomatoes,halved
½cupchoppedfreshbasil
½cupfat-freeItaliandressing
3tablespoonslemonjuice
2clovesgarlic,crushed
¼teaspoonsalt
Freshlygroundblackpeppertotaste
1headcrisplettuce
Placethericeinalargesaladbowlandaddtheartichokes,scallions,tomatoes,
andbasil.Mixgently.
Combine the italian dressing, lemon juice, garlic, salt, and pepper in a small
bowl or jar. Whisk or shake until well blended. Pour over the salad and mix
gently.Serveonbedsoflettuceonindividualplates.
MAKES6SERVINGS
Perserving:153calories,4gprotein,32gcarbohydrates,3gsugar,1gtotal
fat,6%caloriesfromfat,0mgcholesterol,4gfiber,376mgsodium
Thai-StyleColeslaw
This easy coleslaw makes a great winter accompaniment to an Asian meal or
spicesupanyothermeal.
3cupsfinelyshreddedgreenorsavoycabbage
1mediumcarrot,shredded
1smallsweetonion,thinlysliced
2tablespoonsmincedfreshmintor2teaspoonsdriedmint
2tablespoonsmincedfreshcilantro,basil,orparsley
2tablespoonslow-sodiumsoysauce
2tablespoonslimejuice
2tablespoonswater
1tablespoonsugar
1tablespoongratedlimepeel
1½teaspoonstoastedsesameseeds
Combine the cabbage, carrot, onion, mint, and cilantro, basil, or parsley in a
servingbowl.
Combinethesoysauce,limejuice,water,sugar,andlimepeelinasmallbowl.
Pouroverthesalad,mixwell,andrefrigerateuntilreadytoserve.Sprinklewith
thesesameseedsbeforeserving.
MAKES4SERVINGS
Perserving:61calories,2gprotein,13gcarbohydrates,8gsugar,1gtotalfat,
10%caloriesfromfat,0mgcholesterol,3gfiber,334mgsodium
RedCabbageSlawwithCranberriesandApples
Thisisaveryeasy,attractive,anddeliciousmake-aheadsaladforwinterholiday
meals.Ablendermakesthevinaigretteinajiffy.
Cranberry-orangeVinaigrette
¾cupFat-FreeOilSubstitute
½cuporangejuice
⅓cupchoppedfreshorfrozencranberries
2tablespoonsredwinevinegar
1½tablespoonschoppedchivesorscallion
1tablespoonbalsamicvinegar
1tablespoonlemonjuice
1tablespoonsugar
1largeclovegarlic,crushed
1teaspoonsalt
Freshlygroundblackpeppertotaste
Salad
1½poundsredcabbage,thinlysliced(about5cups)
¾cupfreshorfrozencranberries
2crispsweetapples,sliced
For the vinaigrette: Blend the oil substitute, orange juice, cranberries, wine
vinegar,chivesorscallion,balsamicvinegar,lemonjuice,sugar,garlic,salt,and
pepper in a blender. If making ahead, transfer to a covered container and
refrigerate.
Forthesalad:Combine thecabbage,cranberries, andvinaigrettein amedium
saladbowlandtossgently.Coverandrefrigerateforatleast2hourstoallowthe
flavors to blend. When ready to serve, slice the apples (with peel), add to the
salad,andtosswell.
MAKES8SERVINGS
Perserving:70calories,1gprotein,18gcarbohydrates,11gsugar,0.5gtotal
fat,2%caloriesfromfat,0mgcholesterol,3gfiber,251mgsodium
SautéedPortobelloMushroomSalad
Thisisaverysimpleanddelicioussaladfortwo.
8cupscleanedmixedbabysaladgreens
¼cupFat-FreeOilSubstitute
2tablespoonsbalsamicvinegar
1teaspoonDijonmustard
¼teaspoonsalt
¼teaspooncoarselygroundblackpepper
2largeportobellomushrooms
Wineorvegetablebroth
4scallions,sliced
Dividethegreensbetweentwoservingplates.Inasmallbowl,whisktogether
theoilsubstitute,vinegar,mustard,salt,andpepper.Setaside.
Removethestemsfromthemushroomsandscrapeawaythedarkgillswiththe
edgeofaspoon.
Heat a large, heavy nonstick skillet over high heat and add the mushrooms.
Coverandcookuntilslightlybrownedonthebottomsandbeginningtoreleasea
bit of liquid. Add a very small amount of wine or broth as needed to prevent
sticking.Turnthemushroomsandbrowntheotherside.
Quickly slice the mushrooms and place them evenly over the greens. Drizzle
withthedressing,sprinklewiththescallions,andserveimmediately.
MAKES2SERVINGS
Perserving:95calories,7gprotein,19gcarbohydrates,4gsugar,1gtotalfat,
6%caloriesfromfat,0mgcholesterol,7gfiber,308mgsodium
BLTSalad
A salad version of the well-loved sandwich that uses a handy mayonnaise
substitute.Cooks,pluginyourblenders!
Tofumayonnaise
1package(12.3ounces)reduced-fatextra-firmsilkentofu
2tablespoonscidervinegarorlemonjuice
1⅛teaspoonssalt
½teaspoondrymustard
⅛teaspoonwhitepepper
Salad
6cupstornromainelettuce
6cupscubedsprouted-wheatbread,lightlytoasted
4sliceslow-fatvegetarianbacon,suchasYvesVeggieCanadianBaconor
LightlifeFakin’Bacon
2cupschoppedripefirmtomatoes
2scallions,sliced
½cupcidervinegar
⅓cupFat-FreeOilSubstitute
¼cupTofuMayonnaise
5teaspoonssugar
Freshlygroundblackpeppertotaste
For the mayonnaise: Combine the tofu, vinegar or lemon juice, salt, mustard,
andpepperinafoodprocessororblender(orplacetheingredientsinamedium
bowlanduseahand-heldblender)andprocessuntilverysmooth.Itwillkeepin
acoveredcontainerintherefrigeratorforabout2weeks.
Forthesalad:Combinethelettuce,breadcubes,bacon,tomatoes,andscallions
inalargebowl.
Whisktogetherthevinegar,oilsubstitute,tofumayonnaise,sugar,andpepperin
amediumbowluntilwellblended.Tosswiththesalad.Dividethesaladevenly
among4saladbowlsorplatesandserveimmediately.
MAKES4SERVINGS
Perserving:259calories,13gprotein,42gcarbohydrates,11gsugar,2gtotal
fat,8%caloriesfromfat,0mgcholesterol,10gfiber,639mgsodium
MainCourses
Balkan-StyleSlow-CookerStew
Balkancooking issimilar toGreek cuisine.Serve withtoasted sprouted-wheat
breadorbunsfordipping.
3largeonions,sliced
3clovesgarlic,minced
4largered,yellow,green,ormixedbellpeppers,slicedintothinstrips
12ounceslow-fatchickensubstitutestrips,suchasYvesVeggieChicken
TendersorLightlifeSmartMenuChik’nStrips
1can(14ounces)low-sodiumdicedtomatoes
1smalldriedredchilepepper,seeded
½teaspoongroundcloves
½teaspoongroundcinnamon
¼teaspoongroundallspice
2cupslow-sodiumvegetarianbroth
Salttotaste
Freshlygroundblackpeppertotaste
Heatalarge,heavynonstickskilletoverhighheat.Addtheonions,garlic,and
bell peppers. Steam-fry until the onion softens, adding very small amounts of
waterasneededtopreventstickingandburning.
Place the chicken substitute strips in a slow cooker and spoon the cooked
vegetables on top. Stir in the tomatoes (with juice), chile pepper, cloves,
cinnamon, allspice, and broth.Cookon high for 3 hours. Season with the salt
andblackpepper.
MAKES4SERVINGS
Perserving:185calories,19gprotein,30gcarbohydrates,12gsugar,1gtotal
fat,2%caloriesfromfat,0mgcholesterol,9gfiber,550mgsodium
WhiteBeanandSweetPotatoStew
AllyouneediswholegrainbreadtogowiththisItalian-inspiredstew.
1largeonion,chopped
4clovesgarlic,chopped
3cupscookedor2cans(15ounceseach)cannellini,whitekidney,orgreat
Northernbeans,rinsedanddrained
1can(28ounces)low-sodiumdicedtomatoes
1poundsweetpotatoes,peeledandchopped
12ounceskale,strippedfromstalks,washed,thinlysliced,andbriefly
steamed
8ouncescreminimushrooms,sliced
½cuplow-sodiumvegetarianbroth
½cupdryredwine(canbenonalcoholic)or¼cupdrysherry
1tablespoonvegetarianbaconbits
1teaspoonsalt
1teaspoondriedrosemary
1teaspoondriedthyme
1teaspoondriedbasil
1bayleaf
¼teaspooncrushedredpepper
Salttotaste
Freshlygroundblackpeppertotaste
Steam-fry the onion and garlic in a large, heavy nonstick skillet over medium
heatuntilsoft,addingverysmallamountsofwater,wine,orbrothasneededto
prevent sticking and burning. (Or place in a microwaveable dish, cover, and
microwaveonhighpowerfor5minutes.)
Combine the onions and garlic with the beans, tomatoes (with juice), sweet
potatoes,kale,mushrooms,broth,wine,baconbits,salt,rosemary,thyme,basil,
bayleaf,andredpepperinaslowcooker.Cookonlowfor6to7hoursoron
highfor3to4hours.Removethebayleafandseasonwiththesaltandpepper.
MAKES6SERVINGS
Perserving:257calories,14gprotein,50gcarbohydrates,9gsugar,2gtotal
fat,4%caloriesfromfat,0mgcholesterol,12gfiber,418mgsodium
Lebanese-StyleLentilsandPasta
ThisdeliciousLebanesedishmakesafullmeal.
5cupslow-sodiumvegetarianbroth
1cupuncookedbrownlentils,rinsed
2mediumonions,chopped
2clovesgarlic,chopped
1teaspoongroundcumin
4cupschoppedchard,kale,orothergreensor1package(10ounces)frozen
choppedspinach,thawedandsqueezeddry
4ouncesspaghettiorspaghettini(preferablywholewheat),brokeninto4"-
longpieces
¼cupchoppedfreshparsleyorcilantro(optional)pinchofcayennepepper
2tablespoonslemonjuice
Salttotaste
Freshlygroundblackpeppertotaste
Bringthebrothandlentilstoaboilinamediumsaucepan.Reducetheheatto
low,cover,andcookforabout25minutesoruntilthelentilsaretenderbutstill
holdtheirshape.
Steam-frytheonions,garlic,andcumininalarge,heavynonsticksaucepan,stir-
frypan,ordeepskilletuntilsoft,addingverysmallamountsofwaterasneeded
topreventstickingandburning.(Orplaceinamicrowaveabledish,cover,and
microwaveonhighfor7minutes.)
Pourthe lentils andbroth intothepan withthe onions. Addthe greens,pasta,
parsleyorcilantro,ifdesired,andcayenne.Bringtoaboil,thenreducetheheat
tomedium. Cook,uncovered,for about10 minutesoruntil thepasta istender
andmostofthebrothhasbeenabsorbed,leavingasauce.Addthelemonjuice
andmixwell.Seasonwiththesaltandblackpepper.Servehot.
MAKES4SERVINGS
Perserving:318calories,20gprotein,61gcarbohydrates,7gsugar,1gtotal
fat,3%caloriesfromfat,0mgcholesterol,17gfiber,204mgsodium
LemonandArtichokeTagine(MoroccanStew)
ServethisdeliciousstewwithBulgurWheatandQuinoaPilaf.
2tablespoonswholewheatflour
12ounceslow-fatchickensubstitutestrips,suchasYvesVeggieChicken
Tenders,LightlifeSmartMenuChik’nStrips,orMorningstarFarmsMeal
StartersChik’nStrips
1largeonion,sliced
6clovesgarlic,chopped
2cupsslicedmushrooms
1largegreenorredbellpepper,cored,seeded,andcutintochunks
2cupslow-sodiumvegetarianbroth
1tablespoongroundcoriander
1tablespoondriedparsley
½teaspoonblackpepper
¼teaspoongroundturmeric
¼teaspoongroundginger
¼teaspoonpaprika
¼teaspooncrushedredpepper
1lemon,withpeel,slicedandseeded
1jar(7ounces)marinatedartichokeheartquarters,rinsedunderhotwaterand
drained
Salttotaste
Place the flour in a shallow dish and roll the chicken substitute strips to coat.
Place the strips in a large, heavy, deep nonstick skillet or stir-fry pan over
medium-highheatandcookuntilbrowned.Removefromthepanandsetaside.
Addtheonionandgarlictotheskilletandsteam-fryuntilsoft,addingverysmall
amounts of water as needed to prevent sticking and burning. (Or place in a
microwaveabledish,cover,andmicrowaveonhighfor7minutes.)
Addthestrips,mushrooms,bellpepper,broth,coriander,parsley,blackpepper,
turmeric,ginger, paprika,and redpepper. Placethe lemonslices on topof the
stew,cover,reducetheheat,andsimmerfor30minutes.
Removeanddiscardthelemonslices.Stirintheartichokesandcookjustuntil
heated.Seasonwiththesaltandserveimmediately.
MAKES4SERVINGS
Perserving:165calories,20gprotein,25gcarbohydrates,3gsugar,1gtotal
fat,3%caloriesfromfat,0mgcholesterol,10gfiber,584mgsodium
PastawithLentilMarinaraSauce
Redwine(whichcanbeanonalcoholicvariety)lendsarichflavortothissauce,
whichisreadyinthetimeittakestocookthepasta.
1poundpastaofchoice
1jar(26ounces)fat-freelow-sodiumtomato-basedpastasauce
1can(15ounces)lentils,rinsedanddrained
½cupdryredwine(canbenonalcoholic)orlow-sodiumvegetarianbroth
Salttotaste
Freshlygroundblackpepper
Cookthepastaaccordingtopackagedirections,thendrain.
Meanwhile, combine the pasta sauce, lentils, and wine or broth in a medium
saucepan.Heatgentlyandseasonwiththesaltandpepper.Serveoverthepasta.
MAKES5SERVINGS
Perserving:470calories,19gprotein,91gcarbohydrates,9gsugar,2gtotal
fat,3%caloriesfromfat,0mgcholesterol,8gfiber,173mgsodium
VegetarianMixed-BeanChiliExpress
This chili is an absolutely delicious savory treat. Serve it with brown basmati
rice, sprouted-grain bread or buns, corn or sprouted-wheat tortillas, soft fresh
polentaorcornbread,andasalad.Leftoversfreezewell.
6clovesgarlic,mincedorcrushed
1tablespoonchilipowder(preferablyadarkvariety,suchasancho)
1tablespoondriedoregano
1½teaspoonsgroundcumin
½teaspooncrushedredpepper
1can(28ounces)low-sodiumdicedtomatoes
1½cupscookedor1can(15ounces)pintobeans,rinsedanddrained
1½cupscookedor1can(15ounces)blackbeans,rinsedanddrained
1½cupscookedor1can(15ounces)smallredorredkidneybeans,rinsed
anddrained
3cupshotwater
1½cupsdrytexturedvegetableprotein
1cupfrozenwhole-kernelcorn
1largegreenbellpepper,cored,seeded,andchopped
¼cuplow-sodiumsoysauce
1tablespoonhot-peppersauce
1tablespoononionpowder
1tablespoonunsweetenedcocoapowder
1teaspoonsugar
2tablespoonscornmealormasaharina
Salttotaste
Steam-frythegarlicinalarge,heavynonstickskilletfor2minutes.Addthechili
powder, oregano, cumin, and red pepper and stir-fry for 1 minute. Add the
tomatoes(withjuice),beans,hotwater,vegetableprotein,corn,bellpepper,soy
sauce,hot-peppersauce, onionpowder,cocoa, andsugar.Bringto aboil,then
reduce the heat, cover, and simmer for 15 to 30 minutes. During the last 5
minutesofcooking,sprinklethecornmealormasaharinaoverthetopandstirin
thoroughly.Seasonwiththesalt.
MAKES6SERVINGS
Perserving:329calories,26gprotein,57gcarbohydrates,7gsugar,2gtotal
fat,4%caloriesfromfat,0mgcholesterol,16gfiber,457mgsodium
Black-EyedPeaswithSweetPotatoesandGreens
A wonderful combination of flavors! Serve with brown rice or fat-free
cornbread,withhotsauceontheside.
1package(10ounces)frozenkale,chard,orcollardgreens
4cupslow-sodiumvegetarianbroth
2packages(10ounceseach)frozenblack-eyedpeas,thawedanddrained
2clovesgarlic,minced
1can(18ounces)vacuum-packedunsweetenedsweetpotatoes,drained,
rinsed,andchopped,or2cupscooked
Afewdashesofliquidsmoke
Thawthegreensinthemicrowaveorabowlofboilingwateranddrain.Chop
andcombinewiththebroth,black-eyedpeas,garlic,sweetpotatoes,andliquid
smokeina large saucepan.Bringtoa boil,stirring often,thenreducethe heat
andsimmerfor20to30minutes.
MAKES4SERVINGS
Perserving:412calories,32gprotein,74gcarbohydrates,1gsugar,4gtotal
fat,8%caloriesfromfat,0mgcholesterol,22gfiber,127mgsodium
Indonesian-StyleStir-FriedPasta(Bamie)
Thisdishhasjusttherightexotictouch.
1poundsoyvermicellipasta
1mediumonion,chopped
6clovesgarlic,minced
½–1teaspooncrushedredpepper
2cupsshreddednapaorsavoycabbage
2stalkscelery,slicedthinlyonthediagonal
¼cupwater
6ounceslow-fatbeefsubstitutestrips,suchasYvesVeggieBeefTenders,
LightlifeSmartMenuSteak-StyleStrips,orMorningstarFarmsMeal
StartersSteakStrips
½cuplow-sodiumvegetarianbroth
¼cuplow-sodiumsoysauce
¾tablespoonmaplesyrup
¾tablespoondarkmolasses
2teaspoonscornstarch
1tablespooncoldwater
4scallions,slicedthinlyonthediagonal
Cookthepastainalargepotofboilingwateruntiltender.Draininacolander.
In a large, heavy nonstick wok or a skillet lightly coated with oil or cooking
spray,steam-frytheonion,garlic,andredpepperfor1minute,addingverysmall
amountsofwaterasneededtopreventstickingandburning.
Addthe cabbage,celery, and¼ cupwater. Coverand cookover highheat for
about3minutes.Addthebeefsubstitutestripsandstir-fryforabout1minute.
Combinethebroth,soysauce,maplesyrup,molasses,cornstarch,andcoldwater
in a small bowl. Stir into the pan and cook, stirring, over high heat until it
thickensandboils.
Addthedrainedpastaandtosswellwiththesauce.Topwiththescallionsand
serve.
MAKES6SERVINGS
Perserving:338calories,10gprotein,74gcarbohydrates,19gsugar,1gtotal
fat,2%caloriesfromfat,0mgcholesterol,5gfiber,505mgsodium
QuickSpinachLasagna
Although it takesa little more than an hour tomake this dish, most of that is
cookingtime;preptakesjustafewminutes.
1package(10ounces)frozenspinach,thawed
1poundreduced-fatfirmtofu
1tablespoonchoppedormincedgarlic
1teaspoonsalt
1jar(26ounces)fat-freelow-sodiumtomato-basedpastasauce
1poundwholewheatlasagnanoodles
10buttonmushrooms,sliced,or1cupothervegetableofchoice
¼cupveganparmesanornutritionalyeastflakes
Preheattheovento325°F.
Combinethespinach,tofu,garlic,andsaltinamediumbowl.
Coatthebottomofa9"×13"bakingpanwithtomatosauce,thenaddalayerof
lasagnanoodles, overlappingthemslightly.Spreadhalf ofthespinachmixture
overthenoodles.Followwithanotherlayerofnoodles,thentomatosauce,anda
layerofmushroomsorotherveggies.Repeatuntilthelayersreachthetopofthe
pan.Thefinallayershouldbesaucetoppedwithveganparmesanoryeastflakes.
Covertightlywithfoilandbakefor1hour.Stickaknifethroughthecenterof
the lasagna to be sure the noodles are completely cooked. Let stand for 15
minutes,uncovered,beforeserving.
MAKES8SERVINGS
Perserving:332calories,18gprotein,5gcarbohydrates,7gsugar,5gtotal
fat,9%caloriesfromfat,0mgcholesterol,9gfiber,284mgsodium
RecipebyJenniferReilly,RD
EggplantParmesan
Thisinterpretationofanoldfavoriteappealstomoderntastes,with“béchamel”
sauceandveganParmesanprovidingacreamycontrast.
CreamyBéchamelSauce
½mediumonion,cutintochunks
1cupwater
¾cupcookedorcannedwhitebeans,rinsedanddrained
6ouncesreduced-fatfirmsilkentofu
1tablespoonnutritionalyeastflakes
1teaspoonsalt
¼teaspoondriedgarlicgranules
Eggplant
3poundseggplant,cutinto¼"-thickslices
¾cupfinedrybreadcrumbs
3cupsfat-freetomato-basedpastasauce
2cupsCreamyBéchamelSauce
½cupveganparmesan
For the sauce: Simmer the onion with 1 cup water in a medium saucepan,
covered, for about 10 minutes. Place in a blender or food processor with the
remainingingredientsandblenduntilverysmooth.Thesaucecanberefrigerated
inacoveredcontainerforupto1week.
For the eggplant: Arrange the eggplant slices in a single layer on a nonstick
bakingsheet.Broil3"to4"fromtheheatonbothsidesuntillightlybrownedand
softinside(orgrillonanonstickindoorgrill).
Preheattheovento325°F.Layhalfoftheeggplantinthebottomofa10"round
nonstickbakingpan(orabakingpanlinedwithparchment)andtopwithhalfof
the bread crumbs. Spread with half of the pasta sauce, béchamel sauce, and
veganParmesan.Repeatwiththeremainingingredients.Bakefor20minutes,or
untilbubblyandbrownedontop.
MAKES6SERVINGS
Perserving:262calories,11gprotein,34gcarbohydrates,7gsugar,1gtotal
fat,6%caloriesfromfat,0mgcholesterol,10gfiber,697mgsodium
EasyVeggieFajitas
Thisrestaurantfavoriteiseasytomakeathome.
1mediumonion,cutintostrips
¼cuplow-sodiumvegetarianbrothorwater
1teaspoongroundcumin
3red,yellow,green,ormixedbellpeppers,cored,seeded,andcutintostrips
2cans(15ounceseach)blackbeans,drainedandrinsed
6wholewheattortillas(8"to10")
1cupno-sugar-addedtomatosalsa
Steam-fry the onion in a large, heavy nonstick skillet until soft, adding very
smallamountsofbrothorwaterasneededtopreventstickingandburning.Add
the cumin and bell peppers and cook over medium heat until the peppers are
tender.Heatthebeansonhighinthemicrowavefor1minute.
Placeatortillainalarge,heavyskilletovermedium-lowheat.Add½cupofthe
beansand ½cupof theonionmixture. Foldthetortilla inhalfover thefilling
andcookfor3minutes.Repeatwiththeremainingtortillasandfilling.Topwith
salsaandserve.
MAKES6SERVINGS
Perserving:257calories,13gprotein,50gcarbohydrates,8gsugar,2gtotal
fat,7%caloriesfromfat,0mgcholesterol,11gfiber,408mgsodium
RecipebyJenniferReilly,RD
Sides
OrangeCouscousPilaf
Couscouslookslikeagrainbutisactuallyatypeofsemolinapastathatcooks
quicklyandmakesadelicioussidedish.
2cupslow-sodiumvegetarianbroth
1cupcouscous
1cupgratedcarrots
2largeoranges,peeledandcutintosmallchunks
4teaspoonsgratedorangepeel
2tablespoonsraisins
¼teaspoonsalt
¼teaspoongroundcinnamon
Bringthebrothandcouscoustoaboilinalargesaucepanoverhighheat.Add
thecarrots, oranges, orangepeel, raisins,salt, andcinnamon. Returntoa boil,
then turnoffthe heat,cover, andlet stand for10 minutes oruntil allliquid is
absorbed.Fluffwithafork.
MAKES4SERVINGS
Perserving:238calories,7gprotein,52gcarbohydrates,4gsugar,1gtotal
fat,2%caloriesfromfat,0mgcholesterol,7gfiber,143mgsodium
BrusselsSproutswithLemonandVegetarianBacon
This is a delicious and quick brussels sprout dish. You can partially cook the
sproutsaheadof time,stopthecooking withicewater,and thenassembleand
stir-frythedishinminutesjustbeforeserving.
3poundsbrusselssprouts,trimmedandhalvedvertically
1cupchoppedvegetarianbacon(about8slices),suchasYvesVeggie
CanadianBaconorLightlifeFakin’Bacon
4scallions,chopped
¼cuplow-sodiumvegetarianbrothsalttotaste
Freshlygroundblackpeppertotaste
2tablespoonslemonjuice
Addthebrusselssproutstoasaucepanofboilingwaterandcookfor3minutes.
Drainimmediatelyandplungeintoice-coldwaterto stopthe cookingprocess.
Whentheyarecold,drainwell.
Heatalargenonstickskillet,wok,orstir-frypanoverhighheat.Addthebacon
and scallions and steam-fry until the scallions are soft, adding very small
amountsofwaterasneededtopreventstickingandburning.Addthesproutsand
broth and stir-fry for about 3 minutes. Season with the salt and pepper and
drizzlewiththelemonjuice.Tossandserveimmediately.
MAKES8SERVINGS
Perserving:71calories,12gprotein,5gcarbohydrates,1gsugar,0.5gtotal
fat,6%caloriesfromfat,0mgcholesterol,2gfiber,331mgsodium
BulgurWheatandQuinoaPilaf
Thisisatastysidedishforanymeal.
1cupbulgurwheat
1cupquinoa
1largeonion,chopped
1cupchoppedcelery
4cupslow-sodiumvegetarianbroth
¼cupmincedfreshparsley
1teaspooncrusheddriedrosemaryordriedthymeororegano
Salttotaste
Place the bulgur and quinoa in a dry heavy skillet (such as cast-iron), stir-fry
pan,orwokoverhighheatandcook,stirringconstantly,untilthegrainsmells
toasty.Removefromtheheatimmediatelyandsetaside.
Steam-frytheonionandceleryinalargenonsticksaucepanwithatightliduntil
theonionbeginstosoften.Addthebroth,bulgur,quinoa,parsley,androsemary,
thyme,ororegano. Bringto aboiloverhigh heat,thenreducetheheat tolow
andcook,covered,for20minutes.Letstandfor5minutes.Fluffwithaforkand
seasonwiththesalt.
MAKES8SERVINGS
Perserving:174calories,6gprotein,36gcarbohydrates,1gsugar,2gtotal
fat,7%caloriesfromfat,0mgcholesterol,6gfiber,46mgsodium
BroccoliStir-FryinBlackBeanSauce
Thisisacolorful,quick,andfiber-richaccompanimenttoanyAsian-stylemeal.
1teaspoonmincedorgratedfreshginger
2teaspoonscrushedgarlic
2tablespoonsChineseblackbeansauce
1bunchbroccoli
1largeonion,cutinto6wedgesandlayersseparated
2tablespoonswater
3tablespoonsdrysherryornonalcoholicsweetwine,suchasRiesling
1½teaspoonscornstarchdissolvedin½cupcoldwater
Mashthegingerandgarlictogetherinasmallbowl.Addtheblackbeansauce
andmixwell.
Dividethebroccolifloretsintobite-sizepieces.Peelandchopthestemsinto½"
piecesandstir-frywiththefloretsandonioninamediumskilletoverhighheat.
Add 2 tablespoons water, cover, and cook for 4 to 5 minutes or just until the
broccoliiscrisp-tender(addalittlemorewaterifnecessary).
Addthegingermixture,sherryorwine,andcornstarchmixtureandstiruntilthe
sauceisthickened.Serveimmediately.
MAKES4SERVINGS
Perserving:85calories,6gprotein,15gcarbohydrates,1gsugar,1gtotalfat,
4%caloriesfromfat,0mgcholesterol,0.5gfiber,416mgsodium
RoastedSweetPotatoeswithMoroccanSpices
These sweetpotatoes are easy to prepare,but your guests don’t haveto know
that.Theseedsaddcrunchaswellasspice.
1½poundsorange-fleshedsweetpotatoes,peeled,halvedlengthwise,andcut
crosswiseinto½"slices
¼cupfat-freeItaliandressing
1tablespoonmaplesyrup
1½teaspoonsgratedlemonpeel
1½teaspoonscorianderseeds
1½teaspoonscuminseeds
1½teaspoonsmustardseeds
Salttotaste
Freshlygroundblackpeppertotaste
Positionarackinthebottomthirdoftheovenandpreheattheovento375°F.
Toss the sweet potatoes, dressing, maple syrup, lemon peel, and coriander,
cumin,andmustardseedstogetherinaheavynonstickrimmedbakingsheetor
shallowbakingpan,thenspreadevenlyinashallowlayer.Sprinklewithsaltand
pepper.Roastuntiltenderandgoldenbrown,stirringoccasionally,for30to45
minutes.Servehot.
MAKES5SERVINGS
Perserving:145calories,3gprotein,33gcarbohydrates,9gsugar,1gtotal
fat,3%caloriesfromfat,0mgcholesterol,5gfiber,233mgsodium
RoastedGreenBeans,Fennel,RedPepper,andCauliflowerwith
Dill
Thisisadelicious,easy,andcolorfulvegetablepresentation.
2mediumfennelbulbs,topscutoff,halved,trimmed,andsliced
1mediumcauliflower,trimmed,brokenintoflorets,andsliced
2largeredbellpeppers,cored,seeded,andthicklysliced
6cupsfreshgreenbeans,trimmed,orfrozenwholeyounggreenbeans
½cupfat-freeItaliandressing
2tablespoonslemonjuice
2teaspoonsdrieddillweedor2tablespoonschoppedfreshdill
1teaspoondriedgarlicgranules
¼cupchoppedfennelleaves
Salttotaste
Freshlygroundblackpeppertotaste
Preheattheovento350°F.Combinethefennelbulbs,cauliflower,bellpeppers,
beans,dressing,lemonjuice,dill,garlicgranules,fennelleaves,salt,andblack
pepperinasinglelayerinalarge,shallownonstickbakingpan(usetwopansif
necessarytokeepthevegetablesin1shallowlayer).
Place the pan or pans on the bottom oven rack. Bake for about 40 minutes,
stirringoccasionallywithaspatula,untilthevegetablesaretenderandbeginning
tobrownslightly.Servehot.
MAKES8SERVINGS
Perserving:85calories,4gprotein,19gcarbohydrates,6gsugar,0.5gtotal
fat,3%caloriesfromfat,0mgcholesterol,7gfiber,254mgsodium
Desserts
Chocolate-DippedStrawberries
This treat gives you the taste of rich chocolate with the healthful goodness of
fresh fruit. Wax Orchards fat-free, fruit-sweetened organic fudge toppings are
availableinmosthealthfoodstores.Theycomeinsixvarieties.
¼cupWaxOrchardsfudgetopping
12largefreshwholestrawberries,cleaned,withstems
Heatthetopping inasmallsaucepan justuntilsoftened.Divide equallyinto2
small bowls. Hold the strawberries by the stem ends, dip in the topping, and
enjoy!
MAKES2SERVINGS
Perserving:125calories,1gprotein,29gcarbohydrates,23gsugar,1gtotal
fat,5%caloriesfromfat,0mgcholesterol,4gfiber,41mgsodium
Cranberry–Orange–PearGranolaCrisp
Cranberries, oranges, and pears are made for each other. Serve this crisp with
LemonCrème.
4largefirmripepears,peeled,cored,andthinlysliced
2½cupscranberries,thawediffrozen
Juiceandfinelygratedpeelof1mediumorange
¼teaspoonsalt
¼teaspoonfreshlygratednutmeg
¼teaspoongroundginger
¾cup(6ounces)thawedfrozenpearorapplejuiceconcentrateormixedpear,
apple,andpeachjuiceconcentrate
2tablespoonscornstarch
2cupsreduced-fatgranola(nomorethan4percentcaloriesfromfat),suchas
HealthValley
Preheattheovento400°F.Combinethepears,cranberries,orangejuice,orange
peel, salt, nutmeg, and ginger in a large bowl. Stir the juice concentrate and
cornstarchtogetherinasmallbowl.Immediatelypourintothefruitmixtureand
blendwell.Pourintoa2-quartnonstickbakingdish(orabakingdishlinedwith
parchment).Bakefor20minutes.Removefromtheovenandreducetheheatto
350°F.Stirthefruitmixturethoroughlyandsprinklethegranolaevenlyontop.
Bakefor20to30minutesoruntilthefruitissoft.Servewarm.
MAKES8SERVINGS
Perserving:201calories,3gprotein,51gcarbohydrates,27gsugar,1gtotal
fat,2%caloriesfromfat,0mgcholesterol,7gfiber,101mgsodium
LemonCrème
Thissimplydeliciouscrèmecanbeusedasapuddingoratoppingforfruitor
cake.Allyouneedarethreeingredients(youusethelemonpeelandthejuice)
andyourblender.
1package(12.3ounces)reduced-fatextra-firmsilkentofu,crumbled
⅓cupGradeA(light)maplesyruporagavenectar
3tablespoonsfreshlemonjuice
1tablespoongratedlemonpeel
Blendthetofu,maplesyruporagavenectar,lemonjuice,andlemonpeeluntil
verysmoothinablenderorfoodprocessor(orplaceinabowlanduseahand-
heldblender).Refrigerateinacoveredcontaineruntilchilled.
MAKES1¾CUPS(4SERVINGS)
Perserving:106calories,6gprotein,20gcarbohydrates,17gsugar,1gtotal
fat,5%caloriesfromfat,0mgcholesterol,0.5gfiber,88mgsodium
Variation
Lemon-GingerCrème:Foldin¼cupfinelymincedcrystallizedginger.
PineappleSherbetPops
Youcanmakethisvariationonafavoritesummertreatwithablenderandjust
sixingredients.
1package(12.3ounces)reduced-fatfirmorextra-firmsilkentofu
3tablespoonsagavenectaror⅓cupsugar
4teaspoonslemonjuice
¾teaspoonvanillaextract
1can(19ounces)juice-packedunsweetenedcrushedpineapple
¼teaspooncoconutextract
Placethetofu,agavenectarorsugar,lemonjuice,vanilla,pineapple(withjuice),
andcoconutextractinablenderandprocessuntilsmooth.Pourinto18smallice
popmolds,insertsticks,andfreezeuntilsolid.Toserve,dipthebottomsofthe
moldsinhotwaterforafewsecondssothepopsslideouteasily.
MAKES18SERVINGS
Perpopsicle:30calories,2gprotein,6gcarbohydrates,6gsugar,0.5gtotal
fat,4%caloriesfromfat,0mgcholesterol,0.5gfiber,19mgsodium
BerryMousse
Thisissoeasythatit’shardlyarecipe!Yourblenderdoesmostofthework.This
canbeeatenasapuddingorusedasatoppingforfruit.
1package(12.3ounces)reduced-fatextra-firmsilkentofu,crumbled
2¾cupsthawedfrozenunsweetenedberriesofchoice
3tablespoonssugaror2tablespoonsagavenectar
1tablespoonberryliqueur(optional)
Blendthetofu,berries,sugaroragavenectar,andliqueur,ifdesired,inablender
orfoodprocessoruntilsmooth.Spooninto4puddingdishesandrefrigerateuntil
chilled.
MAKES4SERVINGS
Perserving:123calories,7gprotein,24gcarbohydrates,17gsugar,1gtotal
fat,5%caloriesfromfat,0mgcholesterol,3gfiber,89mgsodium
Orange-ApplesauceDateCake
Thiseasylunchboxcakeis moistand delicious—andevenbetter thenextday.
Theapplesaucereplacesbotheggsandfat.
1cupunsweetenedsmoothapplesauce
1tablespoonlemonjuice
2tablespoonswater
1tablespoongratedorangepeel
1cupwholewheatpastryflour(notregularwholewheatflour)
½cupbrownsugar
¼cupoatflour(oatmealgroundinadryblenderorelectriccoffeemill)or
barleyflour
½teaspoongroundcinnamon
¼teaspoonsalt
⅛teaspoongroundnutmeg
⅛teaspoongroundallspice
1teaspoonbakingsoda
1cupchoppedpitteddates
Preheattheovento350°F.Placetheapplesauce,lemonjuice,and2tablespoons
waterinasmallsaucepanovermediumheatandwarmslowly.Addtheorange
peel.
Mixthepastry flour, brownsugar, oatorbarley flour,cinnamon, salt,nutmeg,
andallspiceinamediumbowl.
Stir the baking soda into the applesauce mixture (it will foam up). Pour
immediatelyintotheflourmixtureandstirbrieflybutthoroughly.
Addthedatesandmixbriefly.Scoopthebatterintoanonstick9"×9"cakepan,
smooththetop,andbakefor10minutes.Reducetheheatto325°Fandbakefor
25to30minutesoruntilittestsdonewithacaketester.Transfertoarackand
cool completely. Make 2 evenly spaced cuts through the cake vertically, then
horizontally,tomake9squares.
MAKES9SERVINGS
Per serving: 169 calories, 3 g protein, 41 g carbohydrates, 24 g sugar, 0.5 g
totalfat,2%caloriesfromfat,0mgcholesterol,4gfiber,199mgsodium
NOTES
INTRODUCTION
1
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Randomized, Controlled, Pilot Intervention Using a Low-Fat, Vegetarian
Diet,”PreventiveMedicine29(1999):87–91.
2
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
CHAPTER1
1
M. Knip et al., “Environmental Triggers and Determinants of Type 1
Diabetes,”Diabetes54,suppl2(December2005):S125–36.
CHAPTER2
1
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21.
2
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andSensitivitytoInsulinofHealthyMen,”ClinicalScience2(1935):67–94.
3
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High-Carbohydrate Diet upon the Serum Lipids in Diabetic Patients,”
Diabetes12(1963):127–32.
4
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Insulin-Treated Men with Diabetes Mellitus,” American Journal of Clinical
Nutrition32(1979):2312–21.
5
R.J.Barnard,T.Jung,andS.B.Inkeles,“DietandExerciseintheTreatment
ofNIDDM:TheNeedforEarlyEmphasis,”DiabetesCare17(1994):1469–
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6
A. S. Nicholson et al., “Toward Improved Management of NIDDM: A
Randomized, Controlled, Pilot Intervention Using a Low-Fat, Vegetarian
Diet,”PreventiveMedicine29(1999):87–91.
7
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
8
A.E.Bunner,C.L.Wells,J.Gonzales,U.Agarwal,E.Bayat,N.D.Barnard.
A dietary intervention for chronic diabetic neuropathy pain: a randomized
controlled pilot study. Nutrition & Diabetes 2015 May 26;5:e158. doi:
10.1038/nutd.2015.8.
9
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
10
I.M.Stratton,A.L.Adler,andH.A.Neil,“AssociationofGlycaemiawith
Macrovascular and Microvascular Complications of Type 2 Diabetes
(UKPDS35):ProspectiveObservationalStudy,”BritishMedicalJournal321
(2000):405–12.
11
UKProspectiveDiabetesStudy(UKPDS)Group,“EffectofIntensiveBlood-
Glucose Control with Metformin on Complications in Overweight Patients
withType2Diabetes(UKPDS34),”Lancet352(1998):854–65.
12
D.Ornishetal.,“CanLifestyleChangesReverseCoronaryHeartDisease?”
Lancet336(1990):129–33.
13
————, “Intensive Lifestyle Changes for Reversal of Coronary Heart
Disease,”JournaloftheAmericanMedicalAssociation280(1998):2001–7.
14
Y.Yokoyama,K.Nishimura,N.D.Barnard,etal.Vegetariandietsandblood
pressure:ameta-analysis.JAMAInternationalMedicine2014;174(4):577–87.
15
K. F. Petersen et al., “Impaired Mitochondrial Activity in the Insulin-
ResistantOffspringofPatientswithType2Diabetes,”NewEnglandJournal
ofMedicine350(2004):664–71.
16
Ibid.
17
L. M. Sparks et al., “A High-Fat Diet Coordinately Downregulates Genes
Required forMitochondrial Oxidative Phosphorylationin Skeletal Muscle,”
Diabetes54(2005):1926–33.
18
A. V. Greco et al, “Insulin Resistance in Morbid Obesity: Reversal with
IntramyocellularFatDepletion,”Diabetes52(2002):144–51.
19
L.M.Goffetal.,“VeganismandItsRelationshipwithInsulinResistanceand
Intramyocellular Lipid,”European Journal of Clinical Nutrition 59 (2005):
291–8.
CHAPTER3
1
D. M. Nathan et al. and the Diabetes Control and Complications
Trial/Epidemiology of Diabetes Interventions and Complications
(DCCT/EDIC) Study Research Group, “Intensive Diabetes Treatment and
Cardiovascular Disease in Patients with type 1 Diabetes,” New England
JournalofMedicine353(2005):2643–53.
2
Diabetes Control and Complications Trial Research Group, “The Effect of
Intensive Treatment of Diabetes on the Development and Progression of
Long-Term Complications in Insulin-Dependent Diabetes Mellitus,” New
EnglandJournalofMedicine329(1993):977–86.
3
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
inWomenwithNormalRenalFunctionorMildRenalInsufficiency,”Annals
ofInternalMedicine138(2003):460–7.
4
J. Karjalainen et al., “A Bovine Albumin Peptide as a Possible Trigger of
Insulin-DependentDiabetesMellitus,”NewEnglandJournalofMedicine327
(1992):302–7.
5
A.C. Alting,R. G.J. M.Meijer, andE. C.H. vanBeresteijn, “Incomplete
elimination of the ABBOS Epitope of Bovine Serum Albumin under
SimulatedGastrointestinalConditionsofInfants,”DiabetesCare20(1997):
875–80.
6
D. Hammond-McKibben and H. M. Dosch, “Cow’s Milk, Bovine Serum
Albumin,and IDDM: CanWeSettle theControversies?” DiabetesCare 20
(1997):897–901.
7
Ibid.
8
American Academy of Pediatrics Work Group on Cow’s Milk Protein and
DiabetesMellitus,“InfantFeedingPracticesandTheirPossibleRelationship
totheEtiologyofDiabetesMellitus,”Pediatrics94(1994):752–4.
9
H.K.Akerblometal.,“DietaryManipulationofBetaCellAutoimmunityin
InfantsatIncreasedRiskofType1Diabetes:APilotStudy,”Diabetologia48
(2005):829–37.
10
P. S. Clyne and A. Kulczycki Jr. Human breast milk contains bovine IgG:
relationshiptoinfantcolic?”Pediatrics87(1991):439–44.
11
K. Sadeharju et al., “Enterovirus Infections as a Risk Factor for Type 1
Diabetes: Virus Analyses in a Dietary Intervention Trial,” Clinical and
ExperimentalImmunology132(2003):271–7.
CHAPTER4
1
L.M.Goffetal.,“VeganismandItsRelationshipwithInsulinResistanceand
Intramyocellular Lipid,”European Journal of Clinical Nutrition 59 (2005):
291–8.
2
E.C. Rizos, E.E. Ntzani, E. Bika, et al. Association between omega-3 fatty
acidsupplementationandriskofmajorcardiovasculardiseaseevents.JAMA.
2012;308:1024-33.
3
S.M.Kwak,S.K.Myung,Y.J.Lee,H.G.Seo;KoreanMeta-analysisstudy
Group... Efficacy ofomega-3fatty acidsupplements (eicosapentaenoic acid
and docosahexaenoic acid) in the secondary prevention of cardiovascular
disease.ArchivesofInternalMedicine2012;172(9):686–94.
4
S. Tonstad, T. Butler, R. Yan, G. E. Fraser. Type of vegetarian diet, body
weight,andprevanenceoftype2diabetes.DiabetesCare.2009;32:791–96.
5
M.Kaushik,D.Mozaffarian,D.Spiegelman,etal.Long-chainomega-3fatty
acids,fishintake,andtheriskoftype2diabetesmellitus.AmericanJournal
ofClinicalNutrition2009;90:613–20;N.D.Barnard,J.Cohen,D.J.Jenkins,
etal.Alow-fat,vegandietimprovesglycemiccontrolandcardiovascularrisk
factors in a randomized clinical trial in individuals with type 2 diabetes.
DiabetesCare2006;29:1777–83.
6
N.D.Barnard,J.Cohen,D.J. Jenkins,G.Turner-McGrievy, L.Gloede, B.
Jaster, K. Seidl, A. A. Green, S. Talpers. A low-fat, vegan diet improves
glycemiccontrolandcardiovascularriskfactorsinarandomizedclinicaltrial
inindividualswithtype2diabetes.DiabetesCare2006;29:1777–83.
7
Y. Papanikolaou et al.,“Bean Consumption by AdultsIs Associated with a
MoreNutrientDenseDietandaReducedRiskofObesity,”presentedatthe
ExperimentalBiologyConference,April1–5,2006,SanFrancisco,CA.
8
V. L. Fulgoni et al., “Bean Consumption by Children Is Associated with
BetterNutrientIntakeandLowerBodyWeightsandWaistCircumferences,”
presented at the Experimental Biology Conference, April 1–5, 2006, San
Francisco,CA.
9
S. J. Kim, R. J. de Souza, V. L. Choo, et al. Effect of dietary pulse
consumption on body weight : a systematic review and meta-analysis of
randomizedcontrolledtrials.AmJClinNutr;2016:103:1213-23.
10
V.Ha,J.L.Sievenpiper,R.J.deSouza,etal.Effectofdietarypulseintake
on established lipid targets for cardiovascular risk reduction: a systematic
reviewandmeta-analysisofrandomizedcontrolledtrials.CanadMedAssoJ.
2014;186:e252-62.
11
D.G.Bailey,G.Dresser,M.O.Arnold.Grapefruit-medicaitonninteractions:
forbiddenfruitoravoidableconsequences?CMAJ.2013;185:309-16.
12
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
inWomenwithNormalRenalFunctionorMildRenalInsufficiency,”Annals
ofInternalMedicine138(2003):460–7.
13
E. Giovannucciet al., “Calciumand Fructose Intakein Relation to Riskof
ProstateCancer,”CancerResearch58(1998):442–7.
14
J.M.Chanetal.,“DairyProducts,Calcium,andProstateCancerRiskinthe
Physicians’HealthStudy,”AmericanJournalofClinicalNutrition74(2001):
549–54.
15
X. Gao,M. P. LaValley, K. L.Tucker. Prospective studiesof dairy product
andcalciumintakesandprostatecancerrisk:ameta-analysis.Journalofthe
NationalCancerInstitute2005dec7;97(23):1768–77.
16
K.M.Wilson,e.L.Giovannucci,L.A.Mucci.Lifestyleanddietaryfactors
in the prevention of lethal prostate cancer. Asian Journal of Andrology.
2012;14:265–74.
17
H. L. Newmark, r. P. Heaney. Dairy products and prostate cancer risk.
NutritionandCancer2010;62(3):297–99.
18
S. C. Larsson, N. Orsini, and A. Wolk, “Milk, Milk Products and Lactose
Intake and Ovarian Cancer Risk: A Meta-Analysis of Epidemiological
Studies,”InternationalJournalofCancer118(2006):431–41.
19
J. M. Genkinger et al., “Dairy Products and Ovarian Cancer: A Pooled
Analysis of 12 Cohort studies,” Cancer Epidemiology Biomarkers &
Prevention15(2006):364–72.
20
B. Qin, P. G. Moorman, A.J. Alberg, etal. Dairy, calcium, vitaminD and
ovariancancer risk inAfrican-American women.British Journalof Cancer
2016;2016;115(9):1122–30.
21
D. J. Jenkins et al., “Glycemic Index of Foods: A Physiological Basis for
CarbohydrateExchange,”AmericanJournalofClinicalNutrition34(1981):
362–6.
22
Ibid.
23
J. Brand-Miller et al., “Low-Glycemic Index Diets in the Management of
Diabetes,”DiabetesCare26(2003):2261–7.
24
N. C. Howarth, e. Saltzman, and s. B. Roberts, “Dietary Fiber and Weight
regulation,”NutritionReviews59(2001):129–39.
25
N. D. Barnard et al., “the Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
26
M.G.Craneandc.Sample,”“RegressionofDiabeticNeuropathywithTotal
Vegetarian(Vegan)Diet,”JournalofNutritionalMedicine4(1994):431–9.
27
A.E.Bunner,c.L.Wells,J.Gonzales,u.Agarwal,E.Bayat,N.D.Barnard.
A dietary intervention for chronic diabetic neuropathy pain: a randomized
controlled pilot study. Nutrition & Diabetes 2015 May 26;5:e158. doi:
10.1038/nutd.2015.8.
28
G.M.Turner-McGrievy,etal.Effectsofalow-fat,vegandietandastepII
diet on macro- and micronutrient intakes in overweight, postmenopausal
women,Nutrition20(2004):738–46.
29
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
inWomenwithNormalRenalFunctionorMildRenalInsufficiency,”Annals
ofInternalMedicine138(2003):460–7.
30
V. Melina, W. Craig, s. Levin. Position of the Academy of Nutrition and
Dietetics:vegetariandiets.JournaloftheAcademyofNutritionandDietetics
2016;116:1970–80.
31
E. C. Westman et al. Effect of a 6-month adherence to a very low
carbohydratedietprogram.AmericanJournalofMedicine113(2002):30–36.
CHAPTER6
1
N. D. Barnard et al., “The Effects of a Low-Fat, Plant-Based Dietary
InterventiononBodyWeight,Metabolism,andInsulinSensitivity,”American
JournalofMedicine118(2005):991–97.
2
N. C. Howarth, e. Saltzman, and s. B. Roberts, “Dietary Fiber and Weight
Regulation,”NutritionReviews59(2001):129–39.
3
Barnardetal.,“TheEffectsofaLow-Fat,Plant-BasedDietaryIntervention.”
4
J. A. Vernarelli, d. C. Mitchell, B. J. Rolls, t. J. Hartman. Dietary energy
densityisassociatedwithobesityandotherbiomarkersofchronicdiseasein
usadults.EuropeanJournalNutrition2015;54:59–65.
5
A. M. Dattilo and P. M. Kris-Etherton, “Effects of Weight Reduction on
Blood Lipids and Lipoproteins: A Meta-Analysis,” American Journal of
ClinicalNutrition56(1992):320–8.
6
E. C. Westman et al., “Effect of a 6-Month Adherence to a Very Low
CarbohydrateDietProgram,”AmericanJournalofMedicine113(2002):30–
6.
7
W.S.Yancyetal.,“ALow-Carbohydrate,KetogenicDietversusaLow-Fat
DiettoTreatObesityandHyperlipidemia,”AnnalsofInternalMedicine130
(2004):769–77.
8
E.L.Knightetal.,“TheImpactofProteinIntakeonRenalFunctionDecline
in Women with Normal Renal Function or Mild Renal Insufficiency,”
AmericanJournalofMedicine118(2005):460–7.
9
J. Coresh et al., “Prevalence of chronic Kidney Disease and Decreased
Kidney Function in the Adult us Population: Third National Health and
Nutrition Examination Survey,” American Journal of Kidney Diseases 41
(2003):1–12.
10
K. D. Hall, t. Bemis, r. Brychta, et al. Calorie for calorie, dietary fat
restrictionresultsinmorebodyfatlossthancarbohydraterestrictioninpeople
withobesity.CellMetabolism.2015;22:427–36.
CHAPTER7
1
G. B. Bolli and J. E. Gerich, “The ‘Dawn Phenomenon’—A Common
OccurrenceinBothNon-Insulin-DependentandInsulin-DependentDiabetes
Mellitus,”NewEnglandJournalofMedicine310(1984):746–50.
2
E.Selvinetal.,“Meta-analysis:A1CandCardiovascularDiseaseinDiabetes
Mellitus,”AnnalsofInternalMedicine141(2004):421–31.
3
National Cholesterol Education Program, “Third Report of the National
Cholesterol Education Program (NCEP) Expert Panel on Detection,
Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult
TreatmentPanelIII)FinalReport,”Circulation106(2002):3143–421.
4
S.M.Grundy,etal.“ImplicationsofRecentClinicalTrialsfortheNational
Cholesterol Education Program Adult Treatment Panel III Guidelines,”
Circulation110(2004):227–39.
5
AmericanDiabetesAssociation,2017
CHAPTER9
1
M. R. Yeomans et al., “Effects of Nalmefene on Feeding in Humans,”
Psychopharmacology100(1990):426–32.
2
D. J. Jenkins et al., “Low-Glycemic Index Diet in Hyperlipidemia: Use of
Traditional Starchy Foods,” American Journal of Clinical Nutrition 46
(1987):66–71.
CHAPTER10
1
J.Hlebowicz,A.Hlebowicz,s.Lindstedt,etal.Effectsof1and3gcinnamon
ongastricemptying,satiety,andpostprandialbloodglucose,insulin,glucose-
dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin
concentrations in healthy subjects. American Journal of Clinical Nutrition
2009;89:815–21.
2
R.M. vandam, F.B. Hu,L.Rosenberg,s.Krishnan, J.R. Palmer.Dietary
calciumand magnesium,majorfood sources,and riskof type2 diabetesin
U.S.blackwomen.DiabetesCare2006Oct;29(10):2238–43.
3
W. Mertz, “Chromium Occurrence and Function in Biological systems,”
PhysiologicalReviews49(1969):163–239.
4
K. N. Jeejeebhoy et al., “Chromium Deficiency, Glucose Intolerance, and
NeuropathyReversedbyChromiumSupplementationinaPatientReceiving
Long-term Total Parenteral Nutrition,” American Journal of Clinical
Nutrition30(1977):531–8.
5
G.W.Landman,h.J.Bilo,s.t.Houweling,N.Kleefstra.Chromiumdoesnot
belong in the diabetes treatment arsenal: current evidence and future
perspectives.WorldJournalofDiabetes2014;5:160–64.
6
S.Jacobetal.,“OralAdministrationofRAC-Alpha-LipoicAcidModulates
Insulin Sensitivity in Patients with Type-2 Diabetes Mellitus: A Placebo-
ControlledPilotTrial,”FreeRadicalBiology&Medicine27(1999):309–14.
7
D.Ziegler,P.A.Low,W.J.Litchy,etal.Efficacyandsafetyofantioxidant
treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the
NATHAN1trial.DiabetesCare2011;34(9):2054–60.
CHAPTER11
1
W. C.Knowleret al.,“Reductionin theIncidence ofType 2Diabetes with
LifestyleInterventionorMetformin,”NewEnglandJournalofMedicine346
(2002):393–403.
2
D. E. Thomas, e. J. Elliott, G. A. Naughton. Exercise for type 2 diabetes
mellitus.CochraneDatabaseSystemReview2006Jul19;(3):cd002968.
3
N.G.Bouléetal.,“EffectsofExerciseonGlycemicControlandBodyMass
inType2DiabetesMellitus:AMeta-AnalysisofControlledClinicalTrials,”
JournaloftheAmericanMedicalAssociation286(2001):1218–27.
4
G.Huetal.,“PhysicalActivity,CardiovascularRiskFactors,andMortality
amongFinnishAdultswithDiabetes,”DiabetesCare28(2005):799–805.
5
————, “Leisure Time, Occupational, and Commuting Physical Activity
andtheRiskofStroke,”Stroke36(2005):1994–9.
6
DiabetesResearchinChildrenNetwork(DirecNet)studyGroup.Theeffects
ofaerobicexerciseonglucoseandcounterregulatoryhormoneconcentrations
inchildrenwithtype1diabetes.DiabetesCare29(2006):20–25.
CHAPTER12
1
N. D. Barnard, L. W. Scherwitz, and D. Ornish. “Adherence and
Acceptability of a Low-Fat, Vegetarian Diet among Patients with Cardiac
Disease,”JournalofCardiopulmonaryRehabilitation12(1992):423–31.
2
D.Ornishetal.,“CanLifestyleChangesReverseCoronaryHeartDisease?”
Lancet336(1990):129–33.
3
————, “Intensive Lifestyle Changes for Reversal of Coronary Heart
Disease.”
4
N. D. Barnard, A. Akhtar, and A. Nicholson, “Factors That Facilitate
Compliance to Lower Fat Intake,” Archives of Family Medicine 4 (1995):
153–8.
5
C.B.EsselstynJr.,“Updatinga12-YearExperiencewithArrestandReversal
Therapy for Coronary Heart Disease (an Overdue Requiem for Palliative
Cardiology),”AmericanJournalofCardiology84(1999):339–41.
6
D.J.Jenkins,A.Mirrahimi,K.Srichaikul,etal.Soyproteinreducesserum
cholesterolbybothintrinsic andfooddisplacementmechanisms.Journalof
Nutrition2010;140(12):2302s–2311s.
7
P. M. Kris-Etherton, F. B. Hu, E. Ros, J. Sabaté. The role of tree nuts and
peanuts in the prevention of coronary heart disease: multiple potential
mechanisms.JournalofNutrition2008Sep;138(9):1746s–1751s.
8
D.J.Jenkinsetal.,“DirectComparisonofaDietaryPortfolioofCholesterol-
Lowering Foods with a Statin in Hypercholesterolemic Participants,”
AmericanJournalofClinicalNutrition81(2005):380–7.
9
A.Poobalan,L. Aucott,W.C. Smith,A.Avenell, r. Jung,J.Broom,A.M.
Grant.Effectsofweightlossinoverweight/obeseindividualsandlong-term
lipidoutcomes—asystematicreview.ObesityReview2004;5(1):43–50.
10
S. Berkow and N. D. Barnard, “Blood Pressure Regulation and Vegetarian
Diets,”NutritionReviews63(2005):1–8.
CHAPTER13
1
M. G. Crane, “Sample c. Regression of Diabetic Neuropathy with Total
Vegetarian(Vegan)Diet,”JournalofNutritionalMedicine4(1994):431–9.
2
D.Ziegler.Efficacyandsafetyofantioxidanttreatment.
3
D.F.Horrobin,“EssentialFattyAcidsintheManagementofImpairedNerve
FunctioninDiabetes,”Diabetes46,suppl2(1997):S90–93.
4
A.A.Sima.Acetyl-L-carnitineindiabeticpolyneuropathy:experimentaland
clinicaldata.CNSDrugs2007;21suppl1:13–23;discussion45–6.
5
I. De Leeuw et al., “Long Term Magnesium Supplementation Influences
Favourably the Natural Evolution of Neuropathy in Mg-Depleted type 1
DiabeticPatients(T1dm),”MagnesiumResearch17(2004):109–14.
6
M. Lu et al., “Prospective Study of Dietary Fat and Risk of Cataract
Extraction among US Women,” American Journal of Epidemiology 161
(2005):948–59.
7
N. Karas-Kuzelicki, V. Pfeifer, J. Lukac-Bajalo. Synergistic effect of high
lactase activity genotype and galactose-1-phosphate uridyl transferase
(GALT) mutations on idiopathic presenile cataract formation. Clinical
Biochemistry2008Jul;41(10-11):869–74.
8
L.Ma,X.M.Lin.Effectsofluteinandzeaxanthinonaspectsofeyehealth.
JournaloftheScienceofFoodandAgriculture2010Jan15;90(1):2–12.doi:
10.1002/jsfa.3785.
9
R. G. Cumming, P. Mitchell, and W. Smith, “Diet and Cataract: The Blue
MountainsEyestudy,”Ophthalmology107(2000):450–6.
10
M.S.Morrisetal.,“ModerateAlcoholicBeverageIntakeandEarlyNuclear
andCorticalLensOpacities,”OphthalmicEpidemiology11(2004):53–65.
11
L. Azadbakht, s. Atabak, A. Esmaillzadeh. Soy protein intake, cardiorenal
indices, and c-reactive protein in type 2 diabetes with nephropathy: a
longitudinalrandomizedclinicaltrial.DiabetesCare2008Apr;31(4):648–54.
12
Y.Yokoyama,K.Nishimura,N.D.Barnard,etal.Vegetariandietsandblood
pressure:ameta-analysis.JAMAInternationalMedicine2014;174(4):577–87.
ABOUTTHEAUTHOR
Neal Barnard, MD, FACC, is the founder and president of the Physicians
CommitteeforResponsibleMedicine.Hehasauthoredmorethan70scientific
publications,aswellas19books,includingthebestsellersPowerFoodsforthe
Brain, 21-Day Weight Loss Kickstart, and Dr. Neal Barnard’s Program for
Reversing Diabetes, and the new Dr. Neal Barnard's Cookbook for Reversing
Diabetes.Dr.Barnardisafrequentlecturerappearingthroughouttheworldand
anadjunctprofessorofmedicineattheGeorgeWashingtonUniversitySchoolof
Medicine.HelivesinWashington,DC.
Thisbookisintendedasareferencevolumeonly,notasamedicalmanual.
Theinformationgivenhereisdesignedtohelpyoumakeinformeddecisionsaboutyourhealth.Itisnot
intendedasasubstituteforanytreatmentthatmayhavebeenprescribedbyyourdoctor.Ifyoususpectthat
youhaveamedicalproblem,weurgeyoutoseekcompetentmedicalhelp.
Mentionofspecificcompanies,organizations,orauthoritiesinthisbookdoesnotimplyendorsementbythe
publisher,nordoesmentionofspecificcompanies,organizations,orauthoritiesimplythattheyendorsethis
book.
Internetaddressesandtelephonenumbersgiveninthisbookwereaccurateatthetimeitwenttopress.
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FirstpublishedinpaperbackbyRodaleInc.inFebruary2008.
©2017,2008,2006byNealD.Barnard,MD
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